margaret higham, md (tufts university) margaret ross, md (boston university) tanya sullivan, fnp-bc...

Margaret Higham, MD (Tufts University)Margaret Ross, MD (Boston University)

Tanya Sullivan, FNP-BC (Wellesley College)

Margaret Higham, MD◦ Medical Director of Tufts University Health Service

Margaret Ross, MD◦ Psychiatrist, Director of Behavioral Medicine,

Boston University

Tanya Sullivan, FNP-BC◦ Associate Director, Wellesley College Health

Service

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

world….

Identify the dilemmas faced by travel abroad programs in managing complex medical and mental health conditions among participants

Describe processes and protocols at two universities to proactively identify medical and mental health conditions which might impact a student’s experience abroad

Discuss real life examples to illustrate how the principles above may be put into action

List some guiding principles Discuss some open questions:

◦ Can you prevent a student from going?◦ How much information may be shared with SA

programs?◦ What are the values of consent forms and

contracts?◦ How and when do you bring the family into

discussion?

Study abroad has become “expected”, a selling point for the college, a “perk”

US commitment to accommodation and inclusion (Americans with Disabilities Act)

Millennial Generation of Students The Shrinking Globe HIPAA, FERPA, issues of confidentiality Insurance issues

Where are the possible points of

INTERVENTION?

ANTICIPATORY GUIDANCE

TARGETED ANTICIPATORY GUIDANCE

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

Pre-Travel Health Screening Form

Consent / Authorization through Study Abroad Office, Health & Counseling

Chart review/ clinician visit◦ Student and destination dependent

Shared spreadsheet maintained by Office of International Studies

No medical/MH details shared

Consequences of noncompliance- ◦ study abroad process placed on hold

Identification of resources

Created and Managed by Office of International Studies- Google Drive

Program App Submit Date

Health Form

Health Clearance

Stone Clearance

Leave Form

Pre-Departure Quiz

Contract & Waiver  

due 6/15/13due 10/1/13    

due 11/1/13

due 11/1/13

due 11/1/13  

due 6/15/13 9/12/13  9/15/13  Xdue 11/1/13

due 11/1/13

due 11/1/13  

due 6/15/13 9/12/13 9/15/13 10/15/13RECEIVED PASSED RECEIVED  

10 Sites, Over 350 Tufts Students Students Required to have “Physical Exam”

Step back, Re-evaluate!

Provide necessary site specific info Identify medical issues needing

accommodation Appropriate use of scarce resources “Do Something” about mental health

ANTICIPATORY GUIDANCE

General information Site specific information Highlight significant LIMITATIONS

“Medical Evaluation”

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

Different presentations depending on destination

Structured Power Point Health Risks/Health Resources Identify Vulnerable Students Getting Students to Attend

Student Medical Questionnaire

Mental Health Consultation Process

Distribute AT Group Visit

Tufts Abroad Programs Student Medical Questionnaire

(Return form to Health Service) YES NO

1. Do you have any allergies to medications, foods, insects or pets? If so, list: 2. Are you taking any prescription medication regularly? If yes, which ones? 3. Do you have any medical problems? Are you under the regular care of a

medical provider? Please explain.

4. Does your health keep you from participating in any physical activities? 5. Have you been under the care of a psychiatrist, psychologist,

therapist or counselor in the past year for any mental health or emotional condition? Have you been prescribed psychiatric medication? If yes, please explain. You will need your provider to complete the Mental Health Consultation Report (attached)

6. Have you been hospitalized in the past 5 years? If so, please explain. 7. Have you had any of the following in the past 5 years?

Asthma Eating Disorder Arthritis Mental Health Condition Diabetes (Depression/Anxiety/Other) Heart Disease Mobility Problems High Blood Pressure Seizure Disorder Stomach/Intestinal Problems Sleep Disorder

Explain any you have checked:

I, ___________________________, an applicant for the Tufts Programs Abroad, give permission for this

information to be shared with the Tufts Programs Abroad office, the Resident Director of the Tufts Program

Abroad in _________________________, and to the related clinic where applicable.

Student Signature: ______________________________________________ Date: ___________________

I have reviewed the following and find no medical contraindication to participation in Tufts Programs Abroad

Medical Form Mental Health Consultation (if applicable)

Clinician Name: ____________________________________________________

Clinician Signature:____________________________________________________ Date: ____________

(Return this Form to Health Service) March 2013

Put ID Label Here

What Supports/Accommodations Needed?

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

Not “Clearance” “CONSULTATION” Goal is to Anticipate Needs, Provide Supports

Clinician Introduced, Normalized FAQ for Mental Health Included

Mental Health Consultation Report Prior to Tufts Programs Abroad

Student Name: _____________________________________________

Tufts Abroad Program in: ___________________________________

Program Date: _____________________________________________ The above student has received mental health care from me from ________, to ________ (dates).

Comment: ____________________________________________________________________

Check appropriate box:

At this time there is no apparent mental health contraindication to participating in the study abroad program.

If student is taking psychiatric medication, the plan for obtaining it while abroad is as follows: _________________________________________________________________________

_________________________________________________________________________

I have suggested that (s)he contact the Tufts Program Abroad Resident Director of her/his program to discuss any anticipated needs for support while abroad. Comments: _________________________________________________________________________________

_________________________________________________________________

I have concerns regarding the student’s ability to participate in the study abroad program. Comments: _________________________________________________________________________________

_________________________________________________________________

Clinician name (print): ___________________________________________________

Signature: _____________________________________________________________

Phone number: __________________________ Date: _______________________

I, ______________________________, an applicant for the Tufts Programs Abroad, give permission to my mental health provider completing this form to release the required mental health information to the Tufts Programs Abroad office and to the Resident Director of the Tufts Program Abroad in ________________________________________.

Student Signature: __________________________________________ Date: __________________

Return form to: Tufts Health Service Medical Clinician: ________________________________

Tufts University Health Service 124 Professors Row Medford MA 02155 Fax: 617-627-3592

Revised January 2013

The Student Doesn’t Disclose?Counselor Doesn’t Think Student Should Travel?

…Sometimes We Can Talk a Student Out of Going Abroad

CLOSING THE LOOP

What is their Value? Pros and Cons Case Example

Disability Service Program Director Outside Providers General Counsel Colleagues

Can you prevent a student from going if they really want to?

How much information can Health and Counseling Services share with Study Abroad Programs?

What are the values of consent forms, and contracts?

How and when do you bring the family into the discussion? When do you bring the student home?

Tanya Sullivan, FNP-BC tsulliva@wellesley.eduMargaret Ross, MD mross@bu.edu

Margaret Higham, MD margaret.higham@tufts.edu