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Mary Christie Quarterly A publication of the Mary Christie Foundation

Starting Young

Supporting wellness before college p. 13

Q&A with George Washington University President Thomas LeBlanc p. 04

Issue 10 | Second Quarter | 2018

Mary Christie Quarterly The Mary Christie Quarterly is a publication of the Mary Christie Foundation, a thought leadership and philanthropic organization dedicated to the health and wellness of young adults.

STAFF Publisher & President Editor & Executive Director Program Manager Art and Layout Director

Robert Meenan Marjorie Malpiede Dana Humphrey Ashira Morris


Robert Caret

Vice Chair

John P. Howe, III


Robert F. Meenan


Marjorie Malpiede


Maryellen Pease


Frederick Chicos


Zoe Ragouzeos

CONTE NTS 04 Q&A: Thomas LeBlanc 09 The Journey Toward A Stigma-Free Campus at Felician University 13 Starting Young 20 Help Along the Way, Part II 25 The Disempowerment Trap Map 30 Opinion: Accessing Care While Abroad 34 Q&A: Adm. James Stavridis 39 Technology Solutions in College Behavioral Health 41 Science Summary

Cover art by Jia Sung Spot illustrations by Fran Murphy

Q&A: Thomas LeBlanc The president of George Washington University on building a campus community Interviewed By Marjorie Malpiede

Newly inaugurated college presidents, particularly those new to the school, have a window in time before the impact of their decisions eclipse that of their predecessors. This affords them the objectivity of an outsider while still being the person in charge. Tom LeBlanc, the new president of George Washington University, is making the most of that objectivity, asking questions and listening carefully to the university community, particularly the students, about how to make GW an even better place to go to college.

ents itself to its students, down to food options and community spaces.

The undergraduate experience tops LeBlanc’s list and it is clear he has carefully considered how that experience unfolds here in the nation’s capital. For a computer scientist and a serious academic, LeBlanc has an uncanny understanding of the social and environmental dynamics that impact a person’s college years. He says it is the interplay of these dynamics that result in how a university pres-

LeBlanc has so many aspirations for GW, it will be interesting to see if, after his inaugural year comes to an end in August, he continues to question and innovate or he settles into the job of running things. From our brief and poignant conversation, it is likely to be a combination of both.


LeBlanc talked of great lessons learned during his tenures at the University of Miami and the University of Rochester; about how to make campuses more equitable; and how to make diversity something students know how to achieve, not just talk about. He applies these lessons to his new job with an acknowledgment of the difference between urban campuses and those “inside the hedges” of leafy suburbs.

Mary Christie Quarterly: As a new president, what are some of the areas you are focusing on, in terms

of change and/or improvement? Thomas LeBlanc: Let’s start with the undergraduate student experience. One of my colleagues had a great line. He said, “You may get married multiple times but you only go to college once.” It really is a defining period in your life and the question is, “Is it a positive experience or not?” The challenge for university administrators and faculty is that the vast majority of us don’t share the undergraduate student experience with our students. We don’t live in the dorms. We’re teaching classes but we’re not taking them. We don’t experience the registrar and student accounts and all these offices in the same way that our students do. And so we always need to make sure we’re on the lookout. I have been spending a lot of time talking to students and you can learn so much just by asking them.

MCQ: What is coming to the surface from all of these conversations? TL: One of the things I’ve heard that has been such an important element of my previous work, particularly at Miami, is the need to better define and cultivate community. We’re in Foggy Bottom at the heart of Washington DC. It is the value proposition in many ways that attracts students to George Washington but we need to know how to make this a positive experience all around, including how to create community in an urban environment. That is a challenge because there is no “inside the hedges and outside the hedges” here. These are public city streets. A metro system. Our dormitories look like apartment buildings. Believe it or not, I spend a lot of time thinking about food because in my day, it was the classic college dining hall where you went to connect with your fellow students, not just your roommates and friends. But here, there is no dining hall. There’s a food court and you’ve got your G World card that you can use at Whole Foods or other vendors. There must be a new way to use the market-driven food options, together with social media, to continue to make having meals a community exercise for students. I’m working on it.

MCQ: So how do you create an identity and sense of belonging when you have no “bubble”? TL: I asked the students about this early on and they talked about the banners. “We think the banners on the buildings help create a sense of community here.” The four corners of our campus have statues of George Washington. Along the streets in between you will see banners on all the light poles that have some message about George Washington and you will see a lot of the buildings have awnings with our signage on it. The fact that the students said they really liked this tells me it’s all a part of creating a campus identity in an urban environment. That got me thinking about community spaces. When I got here, I took my early tour with an eye towards what we have for community spaces. And what I saw were an incredible number of examples of potential community spaces that were under-utilized. I went into an event with a great outdoor patio space that was completely empty. The next time I went, there were umbrellas on the patio with people all around. I said to the folks organizing the event, “Great, it is good to see you

have umbrellas here. Now people will use this space.” They said, “Yeah, but we just brought them out for this party.” I said, “Let’s keep them here all the time and maybe students will use this plaza. Especially when the weather’s nice.” Simple example of community space. My provost went to another campus and he took this great picture of a parking spot that’s been turned into a living room. I’ve got some great parking areas that I could turn into outdoor student spaces and little living rooms. So, it’s thinking about community not just from a dining hall perspective but thinking about community from a space perspective. Think about what you need to get people to go out there. I see people using the limited community spaces we have, which makes me think they would use them if we had more of them. MCQ: Why do you think creating a sense of community is so important to the college experience? TL: There are a number of 05

reasons. Socio-economic factors are a big part of it. I went to college on scholarship; so did Donna Shalala (former president of the University of Miami) who, in my view, was the most student-centric president in America. We were very sensitive to the needs of the broad socio-economic classes represented on our campus. We tried to develop a philosophy that said once you’ve covered the full cost of attendance, possibly through scholarship, and you’re inside our hedges, we want you to have equal access to opportunity. One of the first things Donna did was she stopped charging for laundry. She said, “I don’t want rich kids wearing clean clothes and poor kids wearing dirty clothes.” We provided free shuttles to football games. We provided free tickets to the games. Every lecture on campus, including national outside speakers, was free for students. What we couldn’t do was address socio-economic barriers outside our campus. Some of our students came to school with very expensive cars and some of our kids were homeless in high school. We couldn’t change that but we could change the socio-economic difference you might see on campus. Here, the opportunities for differentiation among students are much greater in the city because you have


Photo by Eric Krupke

George Washington University President Thomas LeBlanc in his office in DC.

less ability to control the environment. Some students can afford to eat prepared meals three times a day at Whole Foods, but the average student can’t. Here, you could walk across the street to something and it might be expensive and some students can go and some students can’t go. We have different housing options and they vary significantly by cost. A single apartment with a kitchen in the city is enormously expensive compared to six people in

a small suite with no kitchen. The other reason this is so important is I think students are yearning for community, perhaps more than ever. I am a computer scientist, not a psychologist or a behavioral health expert, but I spent my whole life around young people. And, if you create opportunities for them to get together and be part of a community, they welcome it, particularly freshmen. One of the things I am work-

ing on with the freshman experience is to create a sense of community around D.C. We are in one of the great cities of the world with tremendous opportunities and it’s right outside. If I walk out of the presidential residence and go three blocks, I’m on the National Mall. Three blocks the other way, I’m at the White House. We need to bring our students to D.C. -- not simply plop them in a dormitory and say, “Hey, you’re in D.C.” We need to show them how to turn D.C. into a living experiment and a living community for them. One can imagine a freshman year experience in which you feel completely overwhelmed. You’re in this city, you’re in this dormitory with 1,000 students in it. You’re in this urban environment for the first time in your life. A lot of kids say, “I want go to college in the city because I didn’t have the city experience before.” It’s a whole different thing when you’re here. Instead of simply putting them there and hoping the right thing happens, assuming the right thing happens, I think we need to program it more. And that helps create community. There’s nothing like going to a museum with 20 floor-mates, as opposed to finding it on your own. And so, I’m working with our leaders here to re-think the freshman year in this regard.

MCQ: Does your effort to integrate students more firmly into the urban community dovetail with your goals around equity on campus? TL: Yes. We have a lot of students who come to college now saying I want to go to a diverse environment, the subtext being I came from a non-diverse environment. But, in many cases, I don’t think they know what that means. They just know diversity sounds good and it is good. But what happens is we take all these kids and we put them together and then it doesn’t always work so well. They don’t understand the sensitivities of each other’s cultures. So, we’ve talked about how to not only do alcohol awareness

ing about race in America is the African American History Museum, and it’s four blocks away. MCQ: What are your views on Greek life? TL: It tends to be a strong social community for students. There can be support systems there. But it also comes with pressure to conform. It comes with a structure that is inherently discriminatory — I will choose you, or not, on any basis that I decide. So that’s a problem, from my point of view. Then there’s the fact that they tend to be heavily associated with alcohol. When I hear that we’re talking about the third or fourth death in the country this year from haz-

An important element of our work is to define and cultivate community.

and sexual assault awareness, but how to raise awareness around diversity issues — really teach how you achieve this — because you can’t just throw 18-year-olds together and think everything will just work out. Again, back to the urban community: I can tell you one of the greatest tools for think-

ing, I’m asking myself, “What world are we living in?” So if the Greek life positives were all there and the negatives weren’t, that would be great but I think a lot of times the problem is that Greek life is the only option. And its an option that says “I want you. I don’t want you.” Think of the amount of health effects that 07

come from the first thing that happened to me at college was I got rejected by the people I wanted to like me. Student organizations aren’t allowed to do that and that’s a huge difference. MCQ: Talk a bit about today’s students. Are they less resilient than other generations? TL: I actually happen to be one of the people who has great faith in this generation. I’m tired of people putting them down. I look at all the things that our generation did to hand them a sour apple. We haven’t been great stewards of the climate. We haven’t been great stewards of the economy. Family incomes are stagnating. We had a generation of people graduating over the last ten years who probably started 20% farther back than their parents did on a comparable basis. So, we haven’t always been great for them and yet many of them are still idealistic. They want to change the world. And, so, I’m very positive about this generation, despite the fact they have many significant challenges. Many of them are struggling in this transition from what was an analog world to a digital world. From what was a physical world to a virtual world. Many adults are struggling with it too but they have the option of opting out. Young people don’t. We’ve cre08

ated a whole different society among these folks and I don’t think we’re doing a great job at helping them adapt to it and that’s what college is really about. MCQ: I read somewhere that you want GW to be less process-oriented and bureaucratic. Is that true? TL: Yes, that’s what the community told me. But it is not unique to GW. It’s just that here, we have an excuse. We’re in Washington so our excuse is, “Well, we’re surrounded by the federal government. It’s natural that we take on characteristics from the federal government.” But being in DC and serving a student population that is so idealistic and so convinced of the power of the government to change the world, we have an obligation to be better than that. And, I think I’m starting to understand a little bit more about how we ended up where we did. People who are not empowered get very risk-averse and so you need to have a culture that empowers your employees. I think that what I’ve heard from this community is we have been so focused on the bottom line that we haven’t had a good way of putting the student experience in the equation and, as a consequence, the students will tell you, and they tell me, they feel like a transaction. They have cards for everything that they

constantly swipe and some of that is just inevitable but we need to change that feeling. One of the things that I think characterizes today’s students, and the best of today’s students, is they don’t want to do one thing. So, we need to facilitate access to a different kind of curriculum and a lot of what I’ve been hearing is there are barriers that are artificial to that in many cases. When you hear “I’m in international relations and I also want to do public health, or I’m in chemistry and I also want to do something in engineering, or study abroad,” we need to remove any artificial barriers to students’ ability to fully sample what we have to offer. It used to be that we talked about producing well-rounded individuals. Steve Jobs was not well-rounded. Bill Gates was not well-rounded. I don’t have a problem, as a computer scientist and as an academic leader, with people who aren’t well-rounded. So I don’t mind people with edges. But you’ve got to allow people to create edges and create well rounded-ness that fits them and their goals. That means you have to allow flexibility because they’ll design things that you never would have thought of.

The Journey Towards a Stigma-Free Campus at Felician University A school-wide effort to eliminate stigma around mental health By Anne M. Prisco, Ph.D & Sharon McNulty, LCP

Anne M. Prisco, Ph.D, President, Felician University

IMAGINE a place where you’re respected and not judged. Where you can feel safe and welcomed, regardless of gender, race, religion, political beliefs or physical and mental abilities. Imagine a place that is stigma free. This vision is a reality at Felician University, a diverse Catholic institution of higher education in the Franciscan tradition with campuses in Rutherford and Lodi, New Jersey. “Our mission and values call us to show compassion, respect for human dignity, and to work for peace and justice,” said Felician’s President, Dr. Anne Prisco. “We want our students to feel support-

ed academically, spiritually, physically and emotionally.” In the fall of 2016, Dr. Prisco participated in a colloquium sponsored by the Mary Christie Foundation that brought together thought leaders in higher education and foundations to discuss the current context of student health and wellness. “As educators, we all know that wellness is critical to academic and life success,” Dr. Prisco said. As the leader of a 75-yearold university rooted in Franciscan values, Dr. Prisco believes that institutions of higher learning have a fur-


ther calling to serve and care for their students. “This notion of care — to both cherish and challenge — places health and wellness central to our role as a university,” Dr. Prisco said. The colloquium provided the time and opportunity to both learn from the experts about recent trends and engage in dialog about what the role of higher education institutions could and should play in addressing the mental health of students. Buoyed by her colloquium experience, Dr. Prisco’s subsequent call to action set the stage for what the University’s community of staff, faculty and students view as a successful launch of endeavoring to be a Felician community that is taking a comprehensive approach to addressing the mental health and wellness of its students.

Felician focused on new initiatives last year by becoming a Stigma-Free-designated campus during Mental Health Awareness month in May 2017. Felician was among the first institutions of higher learning in New Jersey to join the Codey Fund for Mental Health’s Stigma-Free Campaign. Created by former Governor Richard Codey and his wife Mary Jo Codey in 2012, the campaign was founded on the beliefs that access to comprehensive care and quality treatment for individuals with mental illness is a right, and that the stigma associated with mental illness is the single biggest barrier between the people suffering with mental health disorders and the treatment that can change their lives. “The health and wellbeing of our students is at the core of our mission,” said Dr. Prisco. “Our Franciscan values

of respect for human dignity, compassion, transformation, solidarity with the poor, justice and peace, transcend everything we do at the University.” Rolling Out Stigma Free During Spring Break 2017, the Student Affairs and Enrollment professional staff at Felician received all-day training on Mental Health First Aid. This was in preparation for the University’s Mental Health Stigma-Free Campus Kick-off event for the entire campus community on May 3, 2017. “We assembled a Stigma-Free Planning Group including faculty, staff and students to plan our events for the 2017-2018 academic year,” Dr. Prisco said. The Felician community’s planned events were then presented to the President’s Council. The Kick-off Event was very

We want our students to feel supported academically, spiritually, physically, and emotionally.


well attended and involved many local speakers to help destigmatize the utilization of the Counseling Center on campus and mental health resources in the community. Esteemed speakers included Senator Codi, Bergen County Executive James Tedesco III, East Rutherford Mayor James Casella, Rutherford Councilwoman Dr. Stephanie McGowan, and student Alexandra Frontin. In the wake of the kick-off, Felician continued to blaze a path in fulfilling its pledge as a Stigma-Free institution of learning. Among the many important initiatives of 2017 and 2018: • Piloted on-line suicide prevention program “Ask. Listen. Refer,” where all members of the college community are trained in suicide prevention annually. • Felician’s CARE team, the school’s behavioral intervention team, resumed under the leadership of the University’s Dean of Students, Dr. Ronald Gray, to respond to students emotional and behavioral concerns in a collaborative and timely manner. • In collaboration with a Department of Justice grant

that Felician University received for sexual violence prevention and response, the University worked collaboratively with its grant Project Coordinator, Leigh Carter, and its Coordinated Community Response Team (CCRT), to update all of the University’s sexual misconduct policies and resource brochures. • Hosted the Clothesline Project, a powerful exhibit designed to raise awareness of the devastating impact violence has on the community. The exhibit featured hundreds of t-shirts created by survivors of personal violence, including sexual assault, domestic violence, stalking, sexual harassment, child abuse and murder. Creating the shirts promoted healing by providing survivors with an avenue to break the silence of their victimization and allowing others insight into their personal experience. • Hosted film screening of the human trafficking documentary, “I Am Jane Doe,”

followed by a panel discussion of experts. • Offered information tables in the dining halls on stress management, self-esteem, PTSD, domestic violence, substance use, mental health issues, and ADHD. • Provided smoking and vaping cessation info tables and alcohol screening events. • Offered therapy dogs during midterms and finals. • Incorporated the Stigma-Free theme into RA and Orientation Leader training sessions and into Parents Panels during SOAR (Summer Orientation, Advising, and Registration days). • Met with the University’s EOF (Educational Opportunity Fund) students and its International students about adjusting to college and overcoming cultural stigma about mental health concerns. • Educated athletes about “Performance Enhancing Drugs” and “Alcohol and/or 11

Photo courtesy of Felician University

Felician University, Bergen County, Rutherford, and New Jersey officials at the kick off event for Felician’s Mental Health Stigma Free Campus initiative.

Recreational Drug Use.” • Conducted a Green Ribbon Campaign (stigma-free suicide prevention), and programs on mindfulness and healthy relationships. • Hosted speaker, Nancy Graham, LCSW, from the Renfrew Center who spoke about “Body Image and Social Media” and featured an art exhibit by art therapy clients in the Center’s eating disorder treatment program. In concert with this important program, the University initiated the “Health at Every Size” campaign for diverse size inclusion. 12

• Launched the University’s first student organization for LGBT students, “Wings of Pride.” • Developed the “Success Strategies” program for students who return from a hospital evaluation or admission to help them succeed upon return to the campus community. While all of this and more has been accomplished in realizing the vision of a Stigma-Free campus at Felician University, clearly this is a process of continuous improvement. All of this was accomplished with campus

support, collaboration, and ingenuity, and with minimal funding. We cannot wait to see what next year’s events have in store for us at Felician University. Anne M. Prisco, Ph.D is the President of Felician University. Sharon McNulty, LPC, ACS, BCPC, NCC, DRCC, CCTP is the Director of Felician University’s Counseling Center.

Starting Young

Supporting wellness before college By Nichole Bernier TWENTY-FIVE years ago, schools like Belmont Hill and possibly the first time they are

when Head of School Rick Melvoin joined the staff of Belmont Hill, an independent boys’ school west of Boston, the school’s wellness landscape looked something like this. There was one part-time counselor who was also the crew coach and resident director for the small, five-day boarding program. He certainly cared about his students, but his form of counseling sometimes seemed to be on the order of “Sit down, settle down and behave.”

“I remember faculty saying things like, ‘We have that boy with family trouble hiding in the nurse’s office pretending he doesn’t feel well,’” Melvoin recalls. “And the counselor’s way of taking care of things was sort of, ‘Don’t be hiding now. Your job is to be strong, suck it up, and get to class.’” But the landscape has changed, for independent

public high schools around the country, in part because of the crush of demand colleges are experiencing for counseling services: The 2016-2017 Healthy Minds Study from the University of Michigan found that 31 percent of students screened positive for depression, and 26 percent for general anxiety disorder; 22 percent had taken psychiatric medication in the past year. Not surprisingly, high school educators are taking a hard look at what’s happening in the years immediately preceding college to prepare students for the transition and adjustment.

living away from home,” said Denise Pope, a senior lecturer at the Stanford University Graduate School of Education. She is also co-founder of Challenge Success, an educational reform organization that partners with over 300 schools helping students with the academic, social, and emotional tools to thrive. “Not having a grasp of social-emotional learned skills — like communicating, self-regulating — will not make it easy to handle things when you get to college. We know that starting early and focusing on coping skills has a positive effect once kids go away to school.”

“Considering the mental health challenges that are being experienced in college, and counseling services pressed to the limits of their ability, some high schools are taking efforts to help kids address the kinds of issues they might experience at school, which is quite

Workload, stress, and sleep So much to do, so little time. There’s a widespread perception that the more high school students do — AP courses, a language or two, a sport or three, an a capella group or an instrument or both — the 13

more successful they are in the eyes of their parents, their school, their peers, and college admissions officers.

them relax, and give things up. I want the kids to do that if that’s who they are, and I want them to have those opportunities to try things, because they

“There’s a pressure for parents and kids to do all those things, a fear that if they aren’t perfect, they screw up, won’t get into the best schools, and their life will be over. Kids want to take five or six classes, plus all the activities. We have to tell them, ‘I know that’s i m p o r t a n t , Belmont Hill’s campus in Belmont, Mass. but there has to be some give and take here,’” says Mel- probably won’t have it in othvoin, who worries about the er places in their lives. This is balance between obsession the constant push-pull.” and opportunity. There isn’t a letter grade “But it’s not about making awarded for the act of jug14

gling a complex workload in high school. Balance, triage, and time management aren’t considered the learning, per se, just the byproducts of learning. But those healthy habits and coping skills might be the most necessary skills they’ll need in college, when parents aren’t around to help them assess how much is too much — when, say, debate club convenes at midnight, because that’s the only time available after sports, dinner, and homework. “Managing workload is a very important thing. In high school they’re very regi-

mented, with classes and extra-curriculars,” said Pope.

High schools are taking efforts to help kids address the kinds of issues they might experience at college, which is quite possibly the first time they are living away from home.

“Kids who come out of a very highly scheduled environment see holes in their schedule and feel the need to fill them, without realizing that the class hours are based on lots of extra work time, then find themselves without enough time. It’s a big lovely scrumptious buffet of life and activities, but one without the knowledge of whether they can do all that and get the sleep that they need.”

But they don’t always believe that they need it, even when adults tell them that sleep deprivation is linked to triggering depressive episodes —which can also affect high school students loading up on an AP course load. One high school in northern California studied by Pope decided its students would benefit from hearing about the importance of sleep not from adults, but

from students themselves — namely, Stanford University students studying sleep and the brain. “High schools are seeing the importance of starting to promote stress management early on, from getting enough sleep to learning coping techniques, yoga and meditation, and enough exercise to prevent problems,” said Marcia Morris, associate program director of student health psychiatry at the University of Florida College of Medicine. She is also author of The Campus Cure, which sprung from her 2015 article in The New York Times, Dear Parent, Your College Student Had a Psychotic Break. “There’s a culture shift happening about what it means to be ready for college. And that’s critical for

them to be able to handle not just college, but high school.”

Carrying glimmers of college-age awareness down to the high school level is part of what administrations see as the path to wellness, and they are increasingly addressing this under the umbrella of health and physical education programs. One organization that offers them the programming is the JED Foundation, an organization dedicated to empowering teens with the skills and support to thrive. In April 2017, it launched the “Set To Go” campaign in response to observations that students coming into college were not always prepared for the emotional aspects of the transition. “In 2015, the first time we polled college students, 60 percent said they didn’t feel emotionally prepared for their first year, and 80 percent felt very anxious and 15

stressed,” said Sara Gorman, director of high school programming for JED. “We wanted to intervene in the earlier years, and change the culture around preparing for college.” The “Set To Go” program is designed for use in the classroom as part of a health curriculum, with guided discussions for seniors about what

mental health looks like on campus, and education about self-care, emotional difficulties, and healthy behaviors. One independent school in Manhattan that signed on for “Set To Go” did it as a way to address the extraordinarily high level of stress about the college admissions process. “We use it to supplement our current wellness curriculum, getting students, faculty and 16

parents thinking about college and all the transitions that come with it,” said the director of health and wellness for the school, which has a policy of not being quoted in the media. “The stress has always been high here, and it shouldn’t be at that level. JED is a vetted, trusted organization, and they clearly saw a need to address this stuff before problems arise in college, which is very much my own philosophy.” A range of schools are implementing programs in their own ways. Castilleja School, an independent girls’ school in Palo Alto, has bolstered its wellness curriculum in recognition that students who are stressed, anxious, and not getting appropriate nutrition, sleep, and exercise will struggle academically as well as emotionally. Built around its existing PE unit, Castilleja has instituted meditation and yoga, self defense, CPR, and positive body image. Piedmont High School, also

in the Bay area, was an innovator in putting a dedicated wellness center right in its school — a comfortable place with couches and tea where students can drop in for mindfulness or meditation, learn positive coping skills, or speak with someone if they need help. “They put it in a beautiful central location, not in the basement, a place where students want to be,” says Pope. Coping skills High schools are recognizing the importance of offering students someone to talk to, and someone impactful to listen to. Some are initiating discussions to help students recognize the difference between everyday ups and downs, and mental health issues that could benefit from professional guidance. “It’s critical to learn how to talk about things, recognize when you need to change course down the road -- downshift, or switch majors — so they don’t feel something unsolvable is going on,” said Morris.

Bringing in skilled, relatable speakers is one route to getting the conversation going. Cue Ross Szabo, who in 1995 was a popular varsity basketball player and president of his high school class when he attempted to take his own life. Frustrated by shallow, joking attitudes around mental health, he stepped in front of his class and talked candidly about what it’s like to live with bipolar disorder. He’s now the founder of the first youth mental health speakers bureau in the country. Szabo created the Behind Happy Faces Mental Health curriculum used by over 200,000 students nationwide, and last year became a founding faculty member of Geffen Academy at UCLA. By his count, he has spoken to 2 million students at high schools around the country on the issues of mental health. “He has a great story, and a great message. He comes to talk to our juniors and seniors almost every year, tells his story and talks about the importance of asking for help

and how to find it if you don’t feel like you’re getting it. It’s one of the most powerful events we do,” says Michelle Bracken, assistant to the Head of School at Harvard-Westlake School, in Los Angeles, and also a licensed counselor who teaches psychology there. “He has a great way of interacting with the kids, and he’s one of the very few speakers they really react to. They come up to talk to him afterward, and email him.” When Szabo speaks at a school, he talks about statistics, addresses the main mental health challenges students are dealing with, suggests coping mechanisms, and always includes a call to action for everyone to share their stories. “The key is to make it a relatable conversation,” he wrote in an email exchange for this article. “I’ve had a lot of connections in my years of speaking. Students who have come forward to say they were going to kill themselves that day, and sought help instead. Students who have helped others. Students who sought help

for the first time for an endless amount of traumas.” Experts attest that the end goal of any wellness programming is to normalize the experience of asking for help when it’s needed, then making that help available. In response to the college counseling crisis — a consistent increase in demand, and a waiting list of professional hours to meet it — many high schools are increasing their own counseling staffs and services. In 2012, San Francisco’s University High School (UHS) put in place an innovative mentoring program described as “augmented advising.” When the class of 2020 entered the school, it enhanced the program to become a one-on-one mentoring relationship, one aimed at making each student feel fully known, with individualized attention to goals, challenges, and developing 21st century skills. A case study of the school and program was included in OVERLOADED AND UNDERPREPARED (Denise Pope, Maureen Brown, and Sarah Miles), 17

a book of studies and strategies for stronger high schools. It appears to be making a difference. “There is a lack of cliquishness, and we see more reaching out to adults and asking for help,” noted UHS Dean of Students Alex Lockett. “Seeking out support is now a norm, whereas before it was seen as a sign of weakness.” At Belmont, where Melvoin is departing this year as Headmaster, an increased attention to wellness played prominently in the school’s recently completed strategic plan. Starting this fall, a newly hired full-time wellness educator will become the hub of a health team that has included a counselor (who sets up “affinity groups” for kids dealing with similar issues to meet regularly at lunch), a consulting psychiatrist, a nurse, a director of academic support, and consulting psychologist — internationally renowned child psychologist Michael Thompson, author of RAISING CAIN. “So we have a group, and every week we’re with the up18

per and middle school directors checking in on the kids,” said Melvoin.

level feel more authentically known, and less frenetically playing “the game.”

Beyond wellness programming

Wellesley High School, a public school west of Boston, is looking forward to joining the consortium’s learning process as soon as it opens to public schools this summer. The impetus is one of many at the school to reduce the rat-race feeling of jumping rote hurdles for a diploma, and college acceptance.

As many high schools add wellness to their curriculum, some are targeting acknowledged sources of stress and changing the rules on how students are viewed by themselves and others. A consortium of independent schools has created an entirely new way of assessing performance to replace the traditional transcript — and colleges, by necessity, are going with it. Mastery Transcript has about 112 prestigious independent schools in various stages of replacing typical grades — say, for History, English, Math — with grades for 21st Century skills acquired. Communication. Collaboration. The idea is to replace narrow scores and grades-based admissions assessment with a more three-dimensional view of the student — which in turn helps students at the high school

“They have created a more meaningful way of having your transcript looked at by admissions readers, and this cracks open the door for more authentic ways of assessing kids,” said Jamie Chisum, principal of Wellesley High School. “This is the only thing I’ve seen college admissions respond to. They had to. If Phillips Andover is doing it, colleges aren’t going to not consider their kids. They already have admissions readers who get all kinds of alternative transcripts.” Wellesley High School has implemented some elements of Challenge Success along

with other programming designed to lower stress and heighten meaningful learning in high school. There are small things designed to simply inject joy in an ordinary day—like bringing baby barnyard animals to the schoolyard to break up finals period, having an a capella group in the lobby singing at the beginning of a random day, or handing out Sweet Tarts during standardized testing days.

“I got tired of kids telling me they just wanted to survive high school. And they meant it,” said Chisum. “If we could find a way for them to have meaning in their learning, that’s what every kid wants, every parent wants, every educator wants. We want kids to be excited about their learning. For some kids it’s changed their lives, their families, it’s been an entire game changer.”

they thought they were looking for. “The hope is they come out of Wellesley High School a little more grounded, more confident that they know themselves as a learner, that there’s a little more meaning behind learning what they’re learning,” said Chisum.

“If they come out of high school and have had a reflective experience, maybe they have a better understanding of who Then there If they come out of high school and have had a they are and are large reflective experience, maybe they have a better where they things, like understanding of who they are and where they want to go the adopin the world want to go in the world a little bit. tion of the a little bit. Evolutions Then when program in they get to 2016. college and The goal of all these initia- have challenges and frustraEvolutions is a school-withtions and bumps in the road in-a-school experiential learn- tives is to focus on the growth and changes in deciding who ing program open to juniors of healthy and curious young they want to be, it’s just a conand seniors, with three tenets people — not stressed-out stu- tinuation of that path.” distinguishing it from a typi- dents struggling to play the cal classroom structure: Col- game, get good scores, defer laboration, interdisciplinary pleasure, and get into one learning, and experiential of a limited number of prestigious colleges where they learning. may or may not find what 19

Help Along the Way, Part II How mental health partners are supporting students and colleges By Marjorie Malpiede

In our last issue, we profiled advocacy organizations that are changing the way colleges and universities are addressing the emotional and behavioral health of students. Our continuing series looks at their partners — the trade organizations that support, inform, and convene the professionals in the field.

The American College Health Association (ACHA) THE annual conference today, the ACHA’s member- has become the most pressing

of the American College Health Association (ACHA) is a must-attend event for anyone in the field of student health and wellness – from campus health center directors to alcohol and drug coordinators to health promotion and counseling center staff. Sought-after destinations like Austin, San Francisco and DC help pump up registration but the crowds each year reflect the convening power of the nation’s leading trade organization for professionals in college student health and wellness.

Founded in 1920 with a group of 20 schools to promote campus health care for students, 20

ship represents over 1,100 institutions, and is the principal leadership organization for advancing the health of college students through advocacy, education, and research. The ACHA represents both two and four-year schools, public and private institutions, and its members represent the student health and wellness needs of more than 10 million college students. ACHA has nearly 3,000 college health care professionals of all disciplines.

This past fall, ACHA hosted its first Mental Health Summit with a robust agenda of panels and speakers focused on what

issue in this field – emotional and behavioral health. “We wanted to highlight what has been one of the most concerning issues to our members and we found that mental health and wellbeing are key areas they are struggling with,” said Dr. Devin Jopp, ACHA’s Chief Executive Officer. Jopp called the Mental Health Summit the first wave of engagement on the topic – meant to raise awareness and acknowledge challenges. This year’s event will focus on the proactive aspects of wellbeing and how to address

upstream factors that impact student health and wellbeing. In addition to its forums, the ACHA is also an enormous resource for student health research, including the oft-cited National College Health Assessment (NCHA). The national survey began as a service to members and has evolved through various versions. ACHA is now finalizing revisions for the third iteration, the NCHA-III, testing the new version of the instrument in Spring 2019 to be implemented in the Fall of 2019.

usually every other year or every three years, depending on the types of analysis they plan to do. The changes to the NCHA have evolved as college health, and all that is included in that term, has also changed. In the NCHA-III, ACHA has built in new measures to gather better information about well-being, resiliency, loneliness, and food insecurity. The new tool continues to use a suicide risk scale, an anger risk scale, and a screening test for alcohol, smoking, and substance use. When students indicate use of alcohol or other drugs, the NCHA in-

them, including whether others have encouraged them to cut down, or if they have tried and been unable to decrease the frequency or amount they’re drinking. ACHA recently launched a faculty and staff health assessment to ensure the wellbeing of those who teach, care for and interact with students. According to Mary Hoban, ACHA’s Chief Research Officer, in an era where campus policies and climate are examined for their role in student health and wellbeing, the health of the faculty and staff can’t be ignored.

The NCHA is designed to be a glimpse into the health and wellness of the student Of the facbody, with ulty and staff the potensurvey, Hotial to idenban said, “We tify areas on We were evaluating what was most concerning really campus that to our members and we found that mental health can’t talk about the need further, more in depth and wellbeing were some of the biggest problems health of the c o m m u n i t y, e x a m i n a - they were struggling with. the campus tion. ACHA’s community as member inan overall enstitutions vironment without addressdistribute the survey to their cludes additional questions ing faculty and staff, too.“ students as often as they need, about the impact it has had on


The ACHA’s forthcoming research initiative, “The Connected College Health Network,” will be a data warehouse that integrates information from various sources to allow for more connections to be made between data points. Data will be pulled from sources that include the NCHA, insurance claims, and medical records. Additionally, the ACHA plans to start creating institutional profiles for its member institutions.

The institutional profile will include information like the number of students served at the health center, the services offered, how many health and wellness staff are employed full time, the number of treatment rooms available, whether students health insurance is offered through the school, whether telehealth or tele counseling is offered, health and wellbeing resources available on campus, and campus policies that support wellness. Over time, the goal is that the Connected College Health Network will allow for connections to be made between, for instance, school policy and behavioral health outcomes. Furthermore, it is expected to yield insights into the correlation between student health and wellness and student retention, success and progression. Jopp believes tools such as these will provide greater support for its members who are overwhelmed with the challenges of addressing students’ emotional and behavioral


health and looking to groups like ACHA, along with NASPA and the American Council on Education (ACE), for best practices, guidance, and advice. “I think this is going to take an army of folks working together to try and solve this,” he said. On October 8th and 9th, ACHA will hold the Student Health Innovation & Leadership Summit on the topic of wellbeing. The two-day forum will look specifically at upstream efforts underway that enhance student wellbeing and will feature a track that addresses how universities are addressing food insecurity and campus homelessness.

The National Association of Student Personnel Administrators (NASPA) NASPA is the country’s relevant today than ever as NASPA’s work in communileading organization for student-centered issues such ty-building, research, convencollege student affairs professionals.

For a hundred years, under previous names (including the National Association of Deans and Advisers of Men), NASPA has been supporting students in “their intellectual, social, moral, and personal development.” From the beginning, NASPA has provided a unique focus not simply on institutions of higher education, but on the young people who are being educated, trained and developed within them. Like the evolution of its name, NASPA, the National Association of Student Personnel Administrators, has changed with the times. The 15,000-member professional development, advocacy, and research organization is more

as sexual assault and Title IX, behavioral health, and student equity have risen to the top of the priority lists of most college and university presidents. NASPA supports the administrators who support the students which, NASPA President Kevin Kruger says, presents a clear alignment of goals.

“The people NASPA represents have chosen higher education because they want to be involved in creating positive learning environments for college students and the coming of age period they experience,” said Kruger. “This is such a critical developmental stage for young adults and supporting students in their emotional and behavioral development is enormously important to our members.”

ing, and advocacy has increasingly focused on how colleges are supporting students’ behavioral health. The organization has been instrumental in making the connection between student health and wellness and academic achievement for all students. “If you think about student success on a national level, which has been articulated as supporting persistence to completion, some of this involves supporting low-income and first general students and some of it is helping those students who are struggling in other facets of their lives.” Through its national conferences, research, and the newly-created position of Vice President for Health and Well-making initiatives,


NASPA is examining student behavioral health through a number of lenses, including ensuring that there are adequate professionals who are able to deal with the more serious psychological issues of today’s students. “We’re urging campuses to think of this from a more holistic standpoint, linking the health centers with the wellness and recreation efforts,” said Kruger. NASPA’s recent advocacy work has included addressing sexual violence on campus at a time when the enforcement strength of Title IX has come into question under the Trump administration. “We feel it is more important than ever to emphasize the work that is being done on campus to address sexual violence — to support victims of sexual violence and to ensure a fair and equitable process acknowledged by the federal government.” For many years now, NASPA has made alcohol and drug use a major part of its agen24

Photo by Rick Reinhard

NASPA President Kevin Kruger at the Mary Christie Foundation and the Hazelden Betty Ford Foundation’s symposium on college substance use.

da. It will continue to do so in light of the continued tragedies and challenges in this area. Kruger recently met with 16 sets of parents whose sons all died in alcohol-related incidents, many due to hazing rituals among fraternities.

“While we have made progress in some of the aspects of high-risk drinking, we are losing too many young men to these tragedies and we’re still transporting too many students to the hospital. This is a place where we really feel we have to do more work.”

The Disempowerment Trap Map New insights on the mental health of young Asian American women By Marjorie Malpiede EXAMINING the emotion- turbing statistic begs further Hahm, who is now Chair al and behavioral health of exploration for schools striv- and Associate Professor of student population groups is proving to be an important, if long-overdue, strategy for colleges and universities. Data from the Steve Fund, a research organization focused on the unique mental health issues of students of color, have helped to amplify variations in issues such as sense of belonging and help-seeking behaviors between white and non-white college students.

One under-examined student group of particular concern is Asian American women. 2015 data conclude that Asian American women between the ages of 15 and 24 have the highest rates of suicide among other similarly-aged women of different race or ethnicities. Considering that Asian American females are among the fastest growing college population group, this dis-

ing to support the behavioral health of their students.

Hyeouk “Chris” Hahm is a South Korean-born clinician/ researcher who has spent the last ten years peeling back the layers of empirical evidence that could provide an explanation for why young Asian American women are at such high risk of suicide. To help articulate her findings, she recently created a tool used as both an intervention and a guide called “The Disempowerment Trap Map.” “What was causing this particular group of women to have such high rates of depression and anxiety became the focus of my intellectual curiosity,” said Hahm, whose doctoral degree is on the impact of acculturation on health risk behaviors of Asian and Pacific Islander (API) adolescents.

Research at Boston University School of Social Work, found very little data existed on this population, so she began her own research in 2005, and has published extensively on the subject ever since.

Through a number of quantitative and qualitative studies, she has interviewed over 1,000 API women, all of whom experienced similar cultural dynamics as 1.5 or second-generation Americans. Hahm says the distinction between first-generation Americans like herself and those whose parents came to this country as immigrants is significant and is a major driver of the stressors that can lead to anxiety and depression. Hahm created the Disempowerment Trap Map as part of the curriculum for a psychotherapy intervention called AWARE (Asian-Amer25

ican Women’s Action in Resilience and Empowerment). She developed the program to target the unique, intertwining issues of family dynamics, trauma, mental health and sexual health among API women. Because of the high concentration of Asian women on college campuses, she is focusing on higher education for the early adoption of her program. It has been implemented at Wellesley College and Boston University and will be available at Harvard in the fall.

Photo by John Gillooly

Hyeouk “Chris” Hahm created the “Disempowerment Trap Map” to visualize why young Asian American women are at high risk for suicide.


The Disempowerment Trap Map is the culmination of Hahm’s research presented in a comprehensive and instructional way designed to help API women articulate and address the underlying factors influencing their mental health. It also serves an eye-opening tutorial for anyone hoping to understand the psycho-social dynamics these women have faced in their young lifetimes. “Severe depression is very complex, and we don’t have

a language to describe it,” Hahm said. “There had been factors identified for these women, like family issues or race, but there was no comprehensive or systemic map to understand why this group of people were so depressed.” Hahm chose the title of her work carefully, citing the association between depression and power. “When people are depressed and are thinking about suicide, they have arrived at a point where they feel powerless,” she said. “Because they feel powerless, they are hopeless.” The key to the map is the layering of five negative stressors leading to a sense of disempowerment. It starts with the individual which Hahm calls “The Inner Voice Trap.” “Many of these women have a sense of perfectionism that is very much internalized,” she said. “They strive for excellence and they are very pressured to be excellent.” According to the map, the standard of self-worth for many API women is how well

they perform. When they are no longer performing well, they often fall into depression or anxiety. From AWARE sessions, Hahm cites comments such as “I feel terrible if I don’t meet expectations;” “I am not good enough compared to all of these outstanding people;” and “Without my achievement, I will be a failure.” These individual perceptions are largely derived from the women’s relationship with their immigrant parents which many report to be overwhelmingly burdensome and in some cases abusive. “The Family Trap” describes the dynamics between first generation immigrant parents and the often unrealistic expectations they place on their children, who are raised to reward and legitimize their parents’ sacrifices in coming to America. As a result, these w o m e n universally reported an enormous sense

of guilt and the constant need to “pay back” their parents with their own performance and achievement. “Their children feel like the pressure never ends,” said Hahm. Another surprising factor uncovered through her research was the prevalence of childhood abuse. “In one of our studies, we found that 60 percent of the women had been physically abused by their own family members,” said Hahm. “Almost none of the abuse was reported, however, because they lived in fear of losing their parents if social services were to be involved.” Hahm says the insular nature of the Asian American family produces a paradox for many of these women. While they felt burdened by their families, and in many cases were abused by them, they


felt powerless to detach from them. In a separate study, Hahm researched the psycho-social dynamics of first generation Asian American parents and learned of mental or physical health problems, language, money, and employment problems, isolation, or marital discord. She concludes that, together, these women and their families were suffering from what they described as “the collective struggle we have in America.”

they are disempowered themselves. They want to raise their children to be successful so that they won’t experience what they have experienced here.” The issue of abuse experienced by these women surfaced again regarding their relationships and sexual health. In one of Hahm’s recent studies drawn from 173 young Asian American women who were seeking mental health intervention, almost half of the participants reported having experienced physical

Severe depression is very complex, and we don’t have a language to describe it.

“Immigrant-related stresses have been affecting all of these family members,” she said. “Because the parents feel like they don’t have control over their place in society,


assault, sexual coercion, or injury due to partner violence in the past six months. Linking relationship abuse to disempowerment, this led to the inclusion of “The Part-

ner Trap” within the map. Threaded throughout each of these disempowerment drivers is the pervasive “Race Trap,” involving microaggression and stereotypes in everyday life. Peer comments such as “you must be good at math,” or coaches and teammates assuming that they are not good enough athletes are examples of micro-aggressions. These include verbal or non-verbal communication that is often hostile or derogatory, or negative racial insults. Hahm says that experiencing microagression often leads to stress, shame, anger, and depression. In addition, despite their academic accomplishments in higher education settings, the Asian Americans Hahm studied were not hopeful of getting ahead and were acutely aware of a “bamboo ceiling” affirmed by statistics. Despite being the fastest growing immigrant group in the country, Asian Americans account for less than 2 percent of CEO’s leading Fortune 500 companies.

Hahm expressed her own frustration at the paucity of Asian American women role models and mentors she has interacted with in her own career in academia.

stress of the issue is worsened by the fact that SAT scores and college admissions tend to be a significant metric of achievement and reward for Asian American families.

Hahm says that one of the most frustrating aspects of the race trap is that even though they experience microagression on a daily basis, their experiences are not typically validated because these are subtle and covert forms of racism.

“They believe the bar is set even higher for them as Asian Americans, which means they end up competing against one another.”

Unlike the African American community that they view as united and vocal in their fight against racism, Asian Americans tend not to come together around these issues. As a result, Asian American women reported feeling as though they were invisible. One exception to this may be in the current debate around potential discrimination in college admissions. “Asian Americans feel very strongly that the college entrance exam system in this country is unfair to them,” said Hahm, who notes that the

The final trap in the map is called “Suffering Alone Trap,” which alludes to the women’s help-seeking behavior. Hahm’s study of 701 AIP women showed that only one third of the high-risk mental health group who has current depression symptoms and history of suicidal ideation sought mental health treatment, and only 15 percent of that group saw therapist at least 8 times in the past year. Part of the explanation is that Asian families, like so many cultures, are affected by stigma and tend to dismiss mental illness. Another is that those who do seek help report that western style psychotherapy treat-

ments were not very helpful. The latter has led Hahm to recruit Asian American counselors to the AWARE program and to train others in the unique issues this population group has experienced. Hahm hopes that this is where “The Disempowerment Trap Map” can be an instructive and effective tool to unlock the multi-dimension of the traps. “The map is meant to help counselors and clients begin the healing process of understanding and addressing the complex and interrelated experiences that influence the mental health of this particular population.” The success of the program thus far has encouraged Hahm to actively promote AWARE on other college campuses. A big motivation she said, has to do with access to the population. “Where do you find concentrations of young Asian American women? In higher education of course.”


Opinion: Accessing While Abroad


How to ensure a safe and healthy study abroad experience

By Adam C. Powell, Ph.D.

Adam C. Powell, President, Payer+Provider Syndicate

OVER the past half-decade, I have spent about two

months per year living away from my home in the United States. I have taught an annual five-week course on Health Information Technology at the Indian School of Business, and then embarked upon trips to China and Europe at other points in the year. My adventures have taken me to many wonderful places; from the Taj Mahal to the Great Wall.


While my lectures have led me to meet numerous Chinese and Indian hospital administrators and physicians, I have also had to experience the healthcare systems of my host countries first hand in times of medical need. As a patient or caregiver, I have seen a student health center, a hospital outpatient care department, a diagnostic testing center, and a retail pharmacy, in addition to visiting countless hospitals as a researcher. While these experiences have not diminished my enthusiasm for travel, they have changed my approach to planning for my health needs. I have been followed abroad by an increasing number of Americans. During the 20152016 academic year, the number of American students increased by 4 percent from the volume during the prior year, to a total of 325,333 students. While more than half of American students studying abroad do so in Europe, about

an eighth do so in Asia and an eighth do so in Latin America. As today’s American students spend time in a wide range of countries, they encounter variation in both how medicine is practiced and how care is financed. I enjoy spending time abroad because it enables me to see different ways of doing things. Countries have different cuisines, architectural styles, musical traditions, and languages. Just as countries differ in other aspects of their cultures, countries all have unique medical cultures. There are international differences in the nature of care available, beliefs on when and how care should be delivered, and in how care is financed. As a result of this variation, I must make preparations to ensure that I will have access to healthcare away from home which is consistent with my preferences.

Countries offer different types and brands of some products and may not offer some products at all. A stubborn pimple led me to discover that it is difficult to buy benzyl peroxide cream in some Chinese pharmacies. On a similar note, after experiencing an intractable infection, I had to purchase antibiotics at an Indian retail pharmacy. While the antibiotics were readily available — without a prescription — the manufacturer of the antibiotics available was unfamiliar to me. Given that there have at times been quality issues with generic manufacturers, I researched the manufacturer in question before taking the medication. In addition to there being international differences in the availability of medications, there are also international differences in the definition of what constitutes illness. Due to differences of opinion between medical societies, as well as physiological differences between populations, not all nations are consistent on even numeric thresholds, such as the minimum body mass index indicative of being overweight.

There are likewise international differences in how different nations address different diseases. Before receiving care for a serious illness, it may be helpful to communicate with an American physician for a second opinion via telemedicine, as the approach to diagnosing and treating illness can vary between nations. Attitudes towards the use of healthcare also differ between nations. As outpatient and hospital care is more affordable in India than in the United States, many of my students in India have sought formal treatment for conditions that would have likely been addressed with watchful waiting in the United States. Students have sent me hospital records, and even copies of x-rays, in unsolicited emails in order to justify absences from class.

Furthermore, the illnesses described in the records — in one case, a stomach ache, and in another case, a sprained ankle — would likely not have warranted a hospital visit nor an absence from class had they occurred in the United States. Different institutions have different approaches to providing care to students in need. The approach used varies depending on the structure of the health system in which the institution resides, as well as the need to integrate with local versus global resources. At the Indian School of Business, primary care is available from an onsite clinic, with referrals to off-campus care at nearby facilities as needed. NYU Shanghai offers its students an onsite Health and Wellness Center, in addi-

I am always a bit surprised when I receive these medical records, as they demonstrate to me that there are differences in expectations of medical privacy when justifying absences across cultures.


tion to access to “The Wellness Exchange Hotline,” a 24/7 line available to NYU students around the world seeking to address mental and physical health concerns. Students studying at the University of Cambridge, and other UK universities, are required to pay a fee to cover healthcare services while obtaining a visa. In exchange for paying this fee, students are offered access to care through the National Health Service (NHS) in the same manner as permanent UK residents. The University of Cambridge additionally offers onsite counseling and a peer hotline. While there is a degree of care that must be taken when receiving medical attention abroad, it is important to not let concerns over healthcare place too great of a damper on international travel. In some cases, care will be provided the same way as it would at home, in some cases care will be provide in a different fashion which may or may not be associated with inferior health outcomes, and in some cases, there may be a lack of access to certain types of quality care. When there is an access to


care issue, one must weigh the value gained from the time abroad against the potential danger of delayed care.

The following steps can be taken to help ensure a safe and healthy time while studying abroad:

As there are also problems with receiving some forms of access to timely medical care in rural areas within the United States, people should also weigh the access to care risks that they are willing to accept at home in making a decision.

• Notify your physician about your plans during a travel medicine visit before leaving, so that you may receive any applicable vaccines, any necessary prophylactic medicines, and prescriptions for medications that you may potentially need while away.

Finally, there can also be healthcare benefits to living abroad. As the cost of care is lower in some countries, spending time in them may provide an opportunity to undergo elective diagnostics or elective procedures. Before doing so, it is important to review the quality and safety record of the facility providing the medical care, the care’s medical necessity, and the potential for a quality issue while delivering the care to cause injury. Joint Commission International accredits healthcare facilities across the world, providing an indicator of the quality of care delivered. Thus, it is possible to treat time abroad as an opportunity for medical tourism, in addition to managing the risk of needing non-elective care.

• Bring the over-the-counter and prescription medications you are likely to need to address basic issues with you when abroad, so that you do not have to worry about the availability or quality of medications locally. • Determine if it is possible for you to contact your home physician by email or telephone while you are away in order to receive advice on non-urgent illnesses that arise. • Research the extent to which minor and major medical treatments are affordable in the country you are visiting. Cost and insurance considerations are more of an issue in some countries than in others, as the cost of care can be quite low in some locations.

• Evaluate the availability of on-campus healthcare resources at your institution abroad and determine the situations in which you will need to supplement the care available with care from off-campus facilities, telemedicine, or care at American institutions. • Examine the quality and

availability of medical facilities near where you plan to visit to determine the extent to which you feel comfortable with receiving care locally or will need to evacuate the country in the event of illness. • Read the fine print of your American health plan to determine the extent of your

coverage outside of the country. If it appears inadequate, consider purchasing additional insurance for catastrophic situations or for emergency evacuation. When visiting nations with national health insurance, review your eligibility to access it.

Stay informed. Read

The MCFeed

The Mary Christie Foundation’s weekly roundup of news and research on the health and wellness of young adults



Q&A: ADM. James Stavridis The Dean of The Fletcher School of Law and Diplomacy at Tufts University on what the world needs from our next generation of leaders Interviewed By Marjorie Malpiede

James Stavridis’ diverse life experiences have afforded him keen insights into a range of critical topics including military strategy, global security and higher ed policy. It is not surprising that his opinions are highly sought after by everyone from television audiences and sitting presidents to his students at The Fletcher School of Law and Diplomacy at Tufts University. The Mary Christie Foundation had the pleasure of talking with Admiral Stavridis as he finishes his last few weeks as Dean of The Fletcher School. It is clear he leaves a post he loves even as he is eager to begin what he calls the “third act” of his life. Stavridis and his wife Laura are headed to Washington DC where he will become the Senior Advisor to the Carlyle Group, one of the largest private equity companies in the world. Taking on a world view has been Stavridis’ master work. An American who was raised for many years in Greece, 34

Stavridis’ first act in life was a thirty-year career in the Navy topped by his post as Supreme Allied Commander of NATO. As Dean of The Fletcher School for the past five years, Stavridis has led the esteemed institution for diplomats-in-training, both internally and externally. His accomplishments in refining the curriculum for some of the most important jobs in the world was augmented by his highly acclaimed thought leadership work. Stavridis is a monthly columnist for Time magazine, and chief international security analyst for NBC News, roles he will continue after he leaves The Fletcher School. In talking about the health and wellness of our future generation of leaders, the Admiral is both broad-minded and specific. He spoke of the rising mental health needs of graduate students and the unique stressors facing The Fletcher population at a time of rapid

change, intense transparency and international unrest. He also discussed the strains facing returning veterans heading to college on the post 9/11 GI Bill and how institutions, including the government, ought to do more to support those who have served. The following is a synopsis of our conversation. Mary Christie Quarterly: What are your thoughts on the rising prevalence of mental health issues in college students? What are you seeing at the graduate level? ADM. James Stavridis: Our campuses of higher education are facing a challenge, veering toward a crisis, in student mental health. I say that both looking at the research on the subject and seeing the number of students that present at clinics with disorders such as anxieties, neuroses, psychosis, bipolar. There has really been an uptick and this is not

just undergraduates. I’m seeing this in my population at Fletcher. Over the five years I’ve been a dean, I would say [the number of students who require mental health intervention] has gone from 10 percent of my population to 20 percent, so it’s effectively doubled in five years. These are, on average, 27-year-old students, many of them international. We have about 45 percent international students, 55 percent from the U.S. When I talk to the other deans here at Tufts and to leaders in higher education as I do, for example, every summer at the Aspen Institute Forum on Higher Education, it is clear that the number of times this subject comes up has also probably doubled over the same five-year period. So I think by any measurement, from the hard statistics of students presenting with challenges, to the apocryphal evidence of number of conversations, this has gone from being a kind of a lower level challenge, something you had to be aware of, to something today that is high on my agenda. MCQ: Why is this so important to you and to The Fletcher School?

JS. It’s crucial that leaders from this school who are going to graduate and go into mid-tier jobs in global diplomacy are stable and centered.

acceleration of events. Students need to be rapidly processing these external events that are just exploding around them.

We cannot afford to have diplomats at our embassies who have mental health conditions and concerns that were masked over in their education at a place like The Fletcher School.

From the end of the Obama administration to the beginning of the Trump administration, you just feel international events are accelerating at a dizzying pace, and this is what students are focusing on.

It is imperative that we address this for our population by virtue of what we’re sending them to do in the world — international diplomacy, global business, international medical activity, humanitarian operations, military operations.

More is happening in a news cycle, in a week, in a month, that happened in a year as recently as a decade ago.

We have, in my view, a special responsibility to ensure that our student body is ready, on day one, to take on these important global missions that we send them on.

And so you come here and events are moving at such speed, you have a sense of frustration and inadequacy and fear and anxiety that I’m going to be launched into this very high-speed world that I am going to contribute to and be part of. The task looks very daunting.

MCQ: What do you think is causing this rise in mental health issues, particularly with your populations of students?

Meanwhile, we are training our students to bring order out of the chaos of a newly international world.

The second point involves transparency. This gets into JS: I think there are three big the personal zone for our stureasons. One is the continuing dents, the way in which they find their lives spread out through social networks and It is crucial that leaders who are going into global the endless commentardiplomacy are stable and centered. ies.




Photo courtesy of Tufts University

Admiral James Stavridis, Dean of the Fletcher School of Law and Diplomacy at Tufts University, on the school’s Medford campus.

very difficult to place yourself in a stable, protected and centered place, when you feel that part of your obligation is to be in this conversation about the world. You may have strong opinions about Israel and Palestine and you roll those out there and you get huge blow back whichever side of the issue you’re on. You may be outraged by something that the Trump administration has done, or by something the Obama administration failed to do, and in both cases, you are caught in huge blow back. 36

Those conversations, and the way students are thrust into them in a very public way, I think contributes to a lot of the anxieties they develop. I’ll add a third, very prosaic piece, and that is cost. Am I getting value out of this very expensive education? Where am I going to find the money to do this? It’s very scary for someone in their late twenties who is looking at years of debt, particularly for international students, living in a foreign country, speaking a foreign language.

There’s an enormous package of very pragmatic stresses that are put on them. MCQ: Would you say your international students are also stressed by the Trump administration’s immigration policies? JS: Absolutely. Let me give you a practical example. I’ve had so many of my international students say that when they land at Logan airport, their heart rate goes up, their anxiety goes sky high. These are people who are here on absolutely rock solid student visas but they say just

the sight of uniforms at the airport scares them.

fessionals who are available to work with these students.

can bring improvement to the world.

We have had a couple of students who were taken to rooms and given hard interrogations. They were from countries that are not favored by the United States but the irony is, we want those students here.

Then we monitor and loop back. When we have identified someone who is in a challenged situation, we want to continue to interact with them, and that goes all the way to me.

MCQ: You spent 32 years in the military and you have a number of servicemen and women attend The Fletcher School each year. What are your views on what they’re going through and how schools can better support them?

That’s exactly how we build the bridges that, in the end, will defuse the kinds of international crises we are experiencing. MCQ: How are you addressing all of this at The Fletcher School? JS: The first thing we do is identify those who are having problems. Second is to talk broadly about it. When we bring in all the students for indoctrination, we have mental health professionals come and communicate to the students that it’s okay to not be okay. Then there are the services we provide. We have a very vibrant, strong university in that department here at Tufts so we’re very fortunate. We have clinics and counselors right in the center of this campus, and a very strong collection of mental health care pro-

I am well-briefed on students that are experiencing these kinds of challenges. We check in on people, we follow up with them frequently. At the dark end of the spectrum, if we have someone who is evincing a sense that they might harm themselves, which of course is a nightmare we face constantly, we need to do a serious intervention. MCQ: Is there something about the work itself you do here at The Fletcher School that becomes a comfort to your students?

JS: I think for our veterans here at The Fletcher School, I’d say, 80 percent of them are at the top of the class, in terms of their stability and their health. But the 20 percent that are challenged, I would argue are even more challenged than the comparatives in the broader population. Our suicide rates in the military are higher than the comparative age demographic so we really need to be checking

JS. Yes. In the midst of the chaos, students are working side by side with people from very different backgrounds on critical issues that they are working through. These exercises give our students comfort that there are solutions to conflicts and there is great hope that they 37

in with this percentage regularly. We have specific veteran support events here at The Fletcher School that I personally am involved in, largely because of my own background. Once a quarter, I get together with all the veterans, and the active duty military who are attending here, which is typically 10 to 15 percent of our population, so that’s 30 to 45 people. In terms of veteran students in general, these are young men and women who have volunteered to serve their country and have gone into very demanding environments, both in terms of the operations they are performing as well as what is expected of them. They have to maintain physical fitness, they have to wear a uniform, they have to obey orders, they don’t lie, they don’t cheat, they don’t steal. It’s a very rigorous moral code that they are willing to place themselves under and limit their own liberties and personal freedoms in doing so. As our young men and women come out of this military environment and suddenly are in the civilian world, there is much more, shall we say, moral ambiguity. No one is going to tell them what to wear on Tuesday, noone is going to check up on them the way the military 38

chain of command looks out for our young soldiers and sailors. That can be very intimidating and very concerning. Then when you couple it for that percentage of the population that has been in combat, it is even more challenging. In that combat group you have Post-Traumatic Stress Disorder (PTSD), you have Traumatic Brain Injury (TBI) from explosives. It’s a very rich mix of challenges that I think add another degree of complexity to their wellbeing that is beyond that of the day-to-day student. They need a lot of support and it is an opportunity for higher education to step up in this area and provide a wellness bridge for these students who have served their country. I also think the government has a role that goes beyond just the VA. It is too important and too challenging for higher ed to do alone. MCQ: What are your views about choosing to go into the military before going to college? JS. First of all, this whole notion that going to a competitive 4-year college is your only choice after high school is really ridiculous and, I believe, contributes to the problems we’ve been talking about.

I think enlisting in the military is a very powerful choice for many young men and women. There are also community college programs that are highly underused in this country. People who come to very expensive institutions are, for their first two years, taking many basic courses. They’re studying Spanish, they’re taking basic psychology, they’re taking calculus. They could be taking those courses at a community college at a fraction of the cost. And in a community college there are solid apprenticeship-type programs where people are learning real skills. The problem is, and it’s the same problem with people enlisting in the military, we have a snobbish society. There’s no other word for it. If you said, ‘My daughter’s going to go into the Navy as opposed to going to college,’ too many people would think ‘What’s wrong with her?’ Or ‘My son is going to community college for two years.’ The response would be ‘Hmm, I wonder if they can’t pay for college?’ That’s absolutely wrong. We’ve got a national education project ahead of us in terms of status.

Technology Solutions in College Behavioral Health New tools to help colleges help their students By Dana Humphrey AS colleges and universi- searching for new solutions, physical health, but also their ties struggle with the increas- saying “We’ll actually be look- academic success and social ing demand for counseling services, students and administrators alike are looking to technological solutions to address the crisis.

Ohio State University launched a counseling mobile app that allows students to make an appointment, access breathing exercises, and contact the clinic in case of an emergency. University of Minnesota expanded their app Learn to Live, an online tool providing mental health screening and other therapy modules, to all five campuses last fall. Harvard University’s Bliss app is designed to improve accessibility by offering a personal approach to navigate through resources on campus. The University of Texas Austin associate director for clinical services told the student newspaper the Daily Texan earlier this year that the health center is

ing at our system over the summer – how we can use technology to make it more effective.” But colleges do not have to create their own solutions, as there are many companies providing new tools to students nationwide. Here are few we profiled: You at College The You at College platform from Grit Digital Health is a student wellbeing portal that compiles campus-specific resources, health promotion content, and tools and assessments created by behavioral health experts. The You at College platform connects students to information that addresses not only their mental and


The portal collects data through lifestyle surveys called Reality Checks, providing students with feedback on their own behavior and steps they can take to improve their wellbeing. The site is customized for the individual student based on these surveys, as well as their demographics and interactions with the site. A campus dashboard allows campus administrators to view aggregate data regarding students’ usage of the site, providing them with a detailed look at their student body’s needs and interests while maintaining conf i d e n t i a l i t y. This data can 39

help inform outreach efforts and programming. The platform is designed to help students and administrators address the challenges of college life proactively. Nathaan Demers, Vice President & Director of Clinical Programs at Grit Digital Health, says that one of the most important aspects of these kinds of tools is that students will find it engaging. According to Demers, Grit consulted college students for their input on the platform from the beginning. Therapy Assistance Online Another platform, Therapy Assistance Online (TAO), provides a suite of evidence-based digital tools for wellbeing resilience and behavioral health. TAO was founded in 2013 by Dr. Sherry Benton, who was working as the director of counseling at a large, public university, when she realized that the long waiting lists at the counseling center could not be resolved by adding more staff. TAO is based on the Stepped Care model, offering more intensive treatment options depending upon the severity of the issues a student is struggling with. It provides self-help tools when students need support and education, and professionally guided help when the student’s problems require a higher level of care. This model is increasingly being adopted at resource-constrained college counseling centers.


The tools in TAO include entertaining, interactive and evidence-based education modules, assessments, screening tools for behavioral health problems, artificial intelligence tools, skill practicing resources, and a video conferencing to connect to a therapist. Campuses can use the tool for student training in well-being and resilience, stress management training, student conduct and conflict resolution, web-based selfhelp and therapist-assisted care assigned by a clinician at the counseling center. A study that compared students using TAO to students completing treatment as usual (one-on-one therapy at university counseling centers) found that students using TAO experienced a greater reduction in their anxiety symptoms. The study also found that both groups participated in a similar number of sessions before ending treatment, an encouraging sign, since a challenge of technology-enhanced therapy is that drop-out rates tend to be higher than for face-toface sessions. Talkspace Talkspace is an online and mobile therapy company that matches customers up with a licensed therapist for a weekly fee. Talkspace recently partnered with the national organizations of the Delta Tau Delta and Alpha Tau Omega fraternities to provide counseling to their members.

Talkspace plans start at $32 a week, which allows unlimited text messages to the therapist, with answers to be expected a few times per day. After completing an assessment and choosing a plan, a customer can be matched with a therapist and start messaging. This product can be especially useful for students in rural areas, where it might be more difficult to find an off-campus therapist. Zencare Zencare, a start-up founded by a Brown University graduate, initially launched to help Brown students connect with off-campus mental health professionals. It’s now three years old and serves clients, about half of whom are college students, in Rhode Island, Massachusetts and New York. Using video profiles, a free initial consultation phone call and an online booking system, the platform simplifies the process of connecting to therapists. The company is working to make therapy more affordable for college students by including therapists who accept school insurance plans, and aims to curate a network of highly diverse therapists. This is a sampling of the many new tools available, and many more entering the market, that can help alleviate the surging demand at college counseling centers while engaging students in the help-seeking process.

Science Summary A recap of research worth noting. By Dana Humphrey


New Study Looks at Cognitive Behavioral Therapy Using Text-Based Conversational Agent

Researchers are exploring how artificial intelligence can be used to help treat depression, anxiety and other mental health issues. Web-based cognitive behavioral therapy (CBT) apps have been shown to be effective but are typically characterized by poor adherence. A recent study examined the feasibility, acceptability, and efficacy of an automated conversational agent, a text-based chatbot, to deliver a self-help program for college students with symptoms of anxiety and depression. For the study, participants aged 18-28 years received 2 weeks of self-help content derived from CBT principles from Woebot, a text-based conversational agent. Participants in the control group were directed to the National Institute of Mental Health ebook, “Depression in College Students.” Analysis showed that, when comparing both groups, regardless of whether they engaged with the content (an intent-to-treat analysis), the group using Woebot significantly reduced their symptoms of depression over the study while those in the information control group did not. In an analysis of only completers, participants in both groups reported significantly reduced anxiety symptoms. This indicates that while both the chatbot and the mental health ebook can be effective tools for treating mental health symptoms, the text chatbot was an engaging way to deliver CBT. Additionally, study participants’ comments suggested that process factors were more influential than content factors for their acceptability of the program. The study determined that automated conversational agents like Woebot are a feasible, engaging, and effective way to deliver CBT.


According to a new study published in Psychological Reports, university stuSurvey Tracks Students’ dents experienced a significant increase in anger, fear, marginalization, and Reactions to the 2016 Election stress after the 2016 election. The participants also reported an upsurge of discrimination. 85 undergraduate students took a daily survey regarding their mood, stress, and mental health before and after the 2016 election. Students reported signs of negative emotions (anxiety, anger, fear) and other aspects of worsening psychological health (stress, poor sleep quality, marginalization, experiencing discrimination) on the day following the election. The study found that while some of these reactions lasted for a day, others — anger, fear, marginalization and experiencing discrimination — evidenced a significant upsurge without a resultant recovery. Michael J. Roche of Penn State Altoona, the author of the study said, “These results apply to the 2016 presidential election, but it is possible that one would find these same results for any presidential election. Future research is needed to see if these reactions were typical or unique to the 2016 presidential election.” 41


A study by the American Council on Education examined the New Study Finds Minority-Serving upward income mobility of Institutions as Engines of Upward students who attended minority-serving institutions, comMobility pared to students who did not. By using federal data, the authors found that minority-serving institutions propel their students from the bottom to the top of the income distribution at higher rates than other institutions. The study also found that minority-serving institutions often enroll students with the lowest family incomes, including first-generation students. These findings suggest that minority serving institutions play an integral role in the education of students from low-income families and communities of color where educational attainment is disproportionately low and income mobility is stagnant. These institutions play this role even while the majority of them have fewer financial resources than other colleges and universities.


A new study published in the Journal of Study Provides Insight on American College Health identifies the characteristics of college students who Repeat Users of Campus have previously received mental health Mental Health Services services on campus and are willing to seek help again. Using data from the National College Health Assessment, the paper examines the characteristics of 12,501 undergraduates who had previously used mental health services on their current campus. Among students who had already utilized campus mental health services, students that were more likely to seek help again in the future were female, white, gay/ lesbian, students not working for pay, students that have the college health insurance plan, and students with no military service. These findings provide insight about how to reach out to students in need of continued support.



Several recent reports have highlighted disparities in college degree attainment for various groups: black and Latino students, first generation students, and single mothers. Two new reports released by the Education Trust, a nonprofit advocacy group, identify states that have the biggest disparities in degree-attainment between white, black and Latino adults. The two reports, one for black adults and one for Latino adults, grade states on an A-to-F scale on both their current degree-attainment levels and on how that level has changed since 2000. The report also rates states on how they’ve closed the gap between white and black or Latino attainment since 2000. The report on black adults notes that the six states with extreme inequality in degree attainment are, in order from most unequal, Connecticut, Minnesota, Massachusetts, Wisconsin, New Jersey, and New York. The six states with extreme gaps in attainment for Latino adults are led by California, followed by Colorado, Nebraska, Massachusetts, Connecticut, and Illinois.

Racial Disparity in Completion Rates

A new white paper from EAB Research, “Reframing the Question of Equity,” demonstrated that despite huge investments, degree attainment disparities between white and Hispanic students has remained unchanged and the gap between white and black students has grown slightly. And low-income, first-generation students are nearly four times more likely than their peers to drop out after their first year. Part of the problem, according to this study, is that minority and first-generation students are more likely to attend college part time, but student-success efforts usually focus on full-time students. The report recommends that community colleges wishing to shrink achievement gaps between white and minority students focus attention on the nearly two-thirds of their students who attend part time. According to another recent report, a briefing paper by the Institute for Women’s Policy Research, just 28 percent of single mothers graduate with a degree or certificate within 6 years of enrollment, and 55 percent leave school before earning a credential. The report states that single mothers in college face substantial time demands that make persistence and graduation difficult. The combination of raising a family, going to class, completing coursework, and holding a job can place serious constraints on single mothers’ time that can force them to make hard choices about their pursuit of higher education. The report authors recommend expanded supports for single mothers that would allow more women to complete college degrees.


MCQ Issue 10 | Summer 2018