ChangingtheWayWeServeStudentsonCollegeCampuses:AMentalHealthResiliencyProgramTransitioningCollegeStudentsonaLeaveofAbsenceBacktoCampusCourtneyJoly-Lowdermilk,M.S.EdSarahSatgunam,LCSWBostonUniversityCenterforPsychiatricRehabilitaEon

Agenda

§ medicalleaveofabsence

§  NITEO:awellnessandresilienceprogram

§  collegementalhealthcoaching

§  programoutcomes

§  discussion

ACHANaEonalCollegeHealthAssessmentII,2014

collegestudentsspeak,and73%ofthosewithamentalhealthcondiEonreport

experiencingamentalhealthcrisiswhileincollegetriggeredbyanxiety,depression,

difficultyadjusEng,stress…

CollegeStudentsSpeak:ASurveyReportonMentalHealth(NAMI,2012)

Eisenberg,D.,Downs,M.F.,Golberstein,E.,Zivin,K.(2009).SEgmaandhelpseekingformentalhealthamongcollegestudents.MedicalCareResearchandReview,66,522-541.

“It’sonlyinthelastmonthortwothatIactuallystartedkeepingmyparentsintheloopabouthowmymoodis.Beforethat…nevermyparents,nevermysister,alwayssecret.Thewholeprocessoftelling[mymom]isgoingtobemoredistressingthanthethingactuallywas…AndthenallthesequesEons.Imean,Ilove[myparents]tobits,butit’slike…[theirsupport]isnotthemost

helpfulthing.”

CollegeStudentsSpeak:ASurveyReportonMentalHealth(NAMI,2012)

collegestudentsspeak,and64%of

thosewithamentalhealth

condiEona;ributetheirleaveof

absencetomentalhealth

NITEO:“thrive,bloom”§  preparetransiEon-agedyouth(18-25)onMLOAforreturntocollege§  increasehope,resilience,andself-determinaEon§  changetypicaltrajectoryofunderachievement

§  onesemester(~14weeks)ofacademicandwellnesscourses§  classesmeet3Emesperweek(~14hours)§  wellness§  mindfulness§  wriEngseminar§  academicseminar§  photovoice§  careerseminar

§  twosemesters(~28weeks)ofcollegecoaching,conEnuedasneeded

WellnessSeminar§  contentareasinclude:

§  domainsofwellness

§  conflictresoluEon

§  choicesandconsequences

§  limitedthinkingpaierns

§  selfcare

§  sexualhygiene

§  drugsandalcoholuse

§  interpersonalrelaEonships,acEvelistening,andempathy

WellnessSeminar

§  PracEcingempathy§  listeningtoandunderstandingothers’perspecEvesandemoEons§  strengtheninginterpersonalrelaEonships§  role-playingusingthescript“Youfeel____because____.”

STUDENTA:“IfItellsomeoneI’mactuallygoingthroughaproblemrightnow,it

feelslikeIfailed,really.ItfeelslikeI’velostcontrol.”STUDENTB:

“Youfeelafraidtoshareyourexperienceswithothersbecauseyoudon’twanttobejudged.”

“…Ihadallthissupport,andIsEllwasstrugglingsomuch.Itwasn’tamaierofhavingtherightsupportsinplace.Ijustwasn’tready.”

“Mydadkindofforcedmetoapply.Butbasically,Ididn’tfeellikeIwasreadytogotocollege.IfeltlikeIdidn’treallywanttogoto

college.”

Mindfulness§  topicareasinclude

§  graEtudepracEce

§  lovingkindnesspracEce

§  meditaEon

§  relaxaEontechniques

§  physiologicalstressresponses

§  cogniEverestructuring

§  hope,opEmism,happiness

§  mindfulnessthroughmarEalarts

WritingSeminar§  topicareasinclude

§  readingfluency

§  criEcalthinking

§  wriEngfluency

§  assisEvetechnology

§  thesisstatementdevelopment

§  ediEng/peerediEng

§  research:findingandusingsources

thenthewriPngassignment…manageEmeorganizeideas

followinstrucEons

startsoffwithatext…sustainaienEon

takenotesconnectwiththetext

thenpapersaregraded…assessperformancecopewithgrade

inquireaboutfeedbackadvocatefordirecEononnextpaper

rewriteandresubmit

“…theanxietysurroundingwillIgetagoodgrade...IwouldworrybeforeIhandedinapaper,andaoerIhandedinapaper,andaoerIgotitback.Everyaspectofa

gradewasstressful.”

“I’mneversaEsfiedwithhowIdothings,unlessIactuallydowell,whichisgeTngAs.”

“IhaveoverlyhighexpectaPonsofmyself,sothenIfeelreallybadwhenImessupali;lebit,andthenitmakesmenotwanttodealwithit.Anditmakesmeblowit

outofproporEon,kindof.Andthenit’soverwhelmingformewhenitshouldn’tbe.”

AcademicSeminar§  topicareasinclude

§  learningstylesandstrategies

§  execuEvefuncEoning

§  test-preparaEon

§  test-taking

§  self-advocacy

§  disabilitydisclosure

§  grouppresentaEons

§  SMARTgoalsepng

“Iputfood[intherefrigerator]andthenI’dforgetaboutit.Keepingmyselforganizedishard.”

“ImaybetoldoneprofessorthatIhada

diagnosis.Ididn’treallytellpeoplebecauseI

startednoEcingthatIfeltlikeIwasbeingtreated

differently…”

PhotoVoice§  topicareasinclude

§  socialjusEce

§  sEgma

§  marginalizaEon

§  careeridenEty

§  empowerment

§  power

§  discriminaEon

§  prejudice

“Thedoctorswroteanotethatsaidheneedstohavelesshomeworkandhemayneedtotakebreaks,andhemaywanttohavestudentsintheclassgivehimtheirnotesbecausehemayhavetrouble

focusingbecausehe’sonacocktailofmeds.IwasonRisperdal,andIwasabsolutelyconkedout.Butthe

schooldidnoneofthat.”

“Themediamakesme…itmakesmefeel...notjustdifferent,butdangerous.”

Weseeanoldforgo;enhome,aplacewearewarnedfromandpredisposedtoavoid.FewseethatitwasoncebeauPfulandfulloflife,aplacewhere

familieslivedandamazingindividualhistorieswerecreated.FewseethetruepotenPalofwhatitoncewasormightbeagain.

“WhatalazyLarry,”onemightstate.Whatifyoufelttrappedinavastimpenetrablebox,filledwithbrackishwater,withseeminglynowaytoescape?Allyoucoulddoiskeepyourheadabovethesurface.Outsideobserversmayjust

seethePpoftheiceberg,aheadlazilybobbinginashimmeringpool.TheirpercepEonskewedbythereflecEonsinthe

water:Ignorance…Incompetence…Selfishness…“Yougoiadosomethingwithyourlife!”

Buttheycan’tseethemassivebo;omandthedarkabyssofdespairbeneaththisobscuringmirror.Nordotheyknowof

yoursensiEveeyesblindedbythesalEness.HowmuchEmehaspassed,youwonder?Howfarhaveyoudrioed?Nowyouareexpectedtoreachtheislandsthatonceencompassedyou:

Achievement…Success…Independence…“Snapoutofit!”

Alone,wouldyoubeabletopiercetheprisonthatholdsyou?

Forsaken,wouldyoubeabletotreadwaterindefinitely?Blinded,wouldyoubeabletoseekouttheislandsthatmaybeanywhere?

OnlyanescapearEstcanliveuptothosestandards.NoprogresswilloccurunElyoureyesarerinsedcleanbythegentleraindrops:

Guidance…Compassion…Time…AreyoureallyalazyLarry?

MichaelGroark

CareerSeminar§  VocaEonalskillsbuilding

§  interviewing§  resumeandcoverleierwriEng

§  Guestssharecareerpaths,triumphs,andfailures§  collegeathleEccoach§  grammy-winningmusician§  veterinarian§  civilrightslawyer§  mentalhealthclinician§  psychiatricrehabilitaEonpioneer

NITEOCoaching

§ CoachingProcessOverview§ SpotlightonCoachingTool:Mapping

Three-PhaseCoachingProcess

PhaseI:Intensive

•  Semester1(w/NiteogroupintervenEon)

• Weeklyface-to-facemeeEngs

• Orient,engage,plan,buildsupports&skills

PhaseII:TransiEon

•  Semester2• Weeklycontact•  FacilitatesuccessfultransiEontorole/environment

PhaseIII:AsNeeded

•  Semester3&beyond

• Contact/supportasneeded

CoachingObjectives§  Increasestudentreadinesstore-engageinpostsecondaryeducaPon§  Promotestudentsenseofhope,self-efficacy,resiliency§  Helpstudentbuildpersonalsupportnetwork§  DevelopandpracEcegoal-orientedskills:academic,self-advocacy,wellness,self-determinaEon,disabilitydisclosure

§  IncreaseeducaPonalandvocaPonala;ainment

§  Setandmonitorprogresstowardacademicandcareergoals§  FacilitatetransiEonbacktocollege§  Supportuseofcampusandclinicalresources

CoachingPracticePrinciples§  student-centered§  forwardprogressisthegoal§  promoteshopeandgrowth§  integratedwithtreatment§  strengths-based§  Eme-unlimited§ meaningfulrole-oriented§  flexiblesupportstoaccommodatestudents§  team-oriented

§  weeklyteammeeEng§  highexpectaEons

CoachingPractice§  SupportCoordinaPon

§  contactdisabilityandcounselingservices§  findclinicians§  scheduleappointmentswithclinicians§  promoteopEmumuElizaEonofclinicalsupports§  collaboratewithteammembers/providers§  developnaturalsupports

§  PreparingforReturn§  Ememanagement/planning§  writeleiersofrecommendaEon§  campustours§  gathersupporEngdocumentaEon§  writepersonalstatement

CoachingPractice§  SkillsPracPce

§  Ememanagement§  goalsepng§  problemsolving§  resiliencybuilding

§  ReadinessAcPviPes§  researchandevaluatejob/volunteer/schoolopportuniEes§  completeapplicaEons§  interviewpreparaEon

§  Homework§  coachwill:§  studentwill:

Three-PhaseCoachingProcess

PhaseI:Intensive

•  Semester1(w/NiteogroupintervenEon)

• Weeklyface-to-facemeeEngs

• Orient,engage,plan,buildsupports&skills

PhaseII:TransiEon

•  Semester2• Weeklycontact•  FacilitatesuccessfultransiEontorole/environment

PhaseIII:AsNeeded

•  Semester3&beyond

• Contact/supportasneeded

Mapping§ CreateseriesofthemaEcmapsoverperiodoffoursessions(twomaps/session)

§ Aoermappingiscomplete,createacEonplan§  Set,review,andadjustgoalsweektoweek(masteryexperiences)

WhatisMapping?§ Mappingisapersonalfuturesplanningtool.(PFPisaguidedprocessthatassistsanindividualtoformulateavisionforhis/herfuture.)

§ MapsarevisualrepresentaEonsofaperson’sstrengths,needs,preferences,andgoals

§  Theplanningprocessisstudent-driven.CoachesfacilitatesbyaskingopenendedquesPonsanddrawingvisualrepresentaPons.

Inspiration:RENEW§  Structuredschool-to-careertransiEonplanningprocess§  Youth(15-21)withemoEonalandbehavioralchallenges§ Benefits:

§  Increasedself-determinaEonandself-efficacyskills§  ImprovedfuncEoninginschoolandcommunity§  ImprovedoutcomesineducaEon/employment

Formoreinfo:h;p://renew.unh.edu

Self-Determination

DefiniPon§ Aperson’srightandabilitytocontrolthedirecEonofhis/herlife

Skills§  Self-Awareness§ Decision-Making§ Planning§ Problem-Solving§  Self-Advocacy§  Self-Confidence

MappingasaCoachingTool§  Anengagementtool§  AfacilitaEontool-focalpointforconversaEon§  Awayforstudentstoprocessexperience§  Arecovery-orientedrecord§  Aprocessforteachingself-determinaEonskills:self-awareness,goal-sepng,problemsolving

TimeOut!Youwantmetodraw?!?!

Doodling:Anti-Intellectual?

hip://www.ted.com/talks/sunni_brown

GraphicFacilitation§ Useoflargescaleimagestoleadpeopletowardsagoal

§ UsedinexecuEveworld&counselingworld

LearningGraphicFacilitation

Basics1.  People2.  Place3.  Process4.  Speech5.  Text(lessismore)6.  Color7.  Effects

The8thElement:VisualLanguageforYourField

h;p://the-doodle-chronicles.tumblr.com/

h;p://the-doodle-chronicles.tumblr.com/

h;p://the-doodle-chronicles.tumblr.com/

NITEOPortfolio§ WhoIAmToday§ MyStory§ MyStrengths&Accomplishments§ MyRelaEonships§ MyFears,Concerns,&Barriers§ MyDreams§ Goals§ ResourcesforSuccess

WhoIAmToday§  Purpose:Gettoknowstudent–whohe/sheis,whatlifeislikeforhim/hertoday

§  PossibleOpen-EndedQuesPons:§  Whataresomeofyourrolesinlife?(e.g.sibling,student,worker,excellentvideogamer)

§  HowdoyoufeelmostoftheEme?Whatdoesagooddaylooklike?Howaboutabadday?

§  Whatdoyouwishwasdifferent?

h;p://www.iod.unh.edu/pdf/RENEW/RENEW_YouthPorgolio_101012.pdf

FromMalloy,J.M.,Drake,J.,Francoeur,K.,ClouEer,H.,Couture,D.,&O’Rourke,S.(2015).“RENEWfacilitator’smanual:AsecondarytransiEonmodelforyouthandyoungadults.”UniversityofNewHampshireInsEtuteonDisability.

Strengths&Accomplishments

§  Purpose:Tohelpstudentinventorytheirstrengths,whichwillbecriEcaltoachievingtheirgoals.

§  QuesPons:§  ThinkaboutEmesinyourlifewhenyouwereproudofyourself,andwhatstrengths,skills,andtalentsyoupossess.

§  Whatwouldyourfamilysay?Whatwouldyourfriendssay?

§  Usereal-Emeinfotofillinthegaps

FromMalloy,J.M.,Drake,J.,Francoeur,K.,ClouEer,H.,Couture,D.,&O’Rourke,S.(2015).“RENEWfacilitator’smanual:AsecondarytransiEonmodelforyouthandyoungadults.”UniversityofNewHampshireInsEtuteonDisability.

MyRelationships•  Purpose:Inventoryofthepeopleinyourlifewhoareimportanttoyouandpeoplewhoyourelyonforhelp.Thisisawaytobrainstormpeoplewhomightsupportyouinworkingtowardyourgoals.

MyGoals•  Whatisthelong-termvision?•  Whatstepscanyoutaketoreachyourgoal?•  Whatstrengthscanyourelyontohelpyoureachyourgoals?•  WhatsupportscanyouuElizetohelpyou?•  Whatmightgetintheway?

GoodPractices…

•  AlwaysbeginbyorienEngstudent•  Usestudent’swordswheneverpossible•  UseyouracEvelisteningskillstofacilitatethedialogue•  Reachforbalance:representposiEveandnegaEve•  EndonaposiEvenote•  SummarizeyourobservaEons,butrefrainfrommaking

interpretaEons

SensitiveTopics

•  UsecauEon/carewhendepicEngsensiEvetopics.•  “Howcanwerepresentthat?”•  Remember,notrelive.

•  IfmappingelicitsdifficultemoEons,helpstudentmakea

plantofollowupwithasupport(e.g.clinician,friend,

etc.)

ProgramEvaluation§  nineteenyoungadults(n=19)

§  Meanageof21years§  12male(63%),6female(32%),1transgenderfemale(5%)

§  allstudentsdisclosedatleastonediagnosis:§  anxietydisorder(53%)§  mooddisorder(53%)§  schizophreniaorotherpsychoEcdisorder(26%)§  ADHD(5%)§  personalitydisorder(5%)§  substance-abusedisorder(11%)§  eaEngdisorder(5%)

§  100%hadsomecollegeexperience§  85%previouslymatriculatedataprivate,4-yearinsEtuEon

demographicscombinedfall2014andspring2015

ProgramEvaluation

*staEsEcallysignificantincreasesinposiEveaffect(p=0.011),emoEonalEes(p=0.018),andpsychologicalwellbeing(p=0.010);*staEsEcallysignificantdecreasesindepressionsubscale(p=0.008)andpsychologicaldistress(p=0.023)

ProgramEvaluation

*staEsEcallysignificantincreasesinhope(p=0.001),goal-directedenergy(p=0.025),planningtowardgoals(p=0.000),andacademicself-efficacy(p=0.026)

ProgramEvaluation §  onemonthpostphase-1oftheprogram:

§  increaseinrateofcollegecourseenrollment(42%to58%)§  increaseinemploymentrate(37%to74%)

§  conEnuetotrackstudents’progress1and2yearspost-program§  collegeenrollment,graduaEon,employmentrates§  qualitaEveexperienceofschool,work,life§  psychosocialandacademicfuncEoning§  useofclinicalandnon-clinicalresources

§  futuretesEngandtracking:neuropsychologicalfuncEoningandacademicfluency

ParentReports“Everyoneneedsan'angel'inhisorherlife:Someonewhogivesyouhope;whobelievesinyounomaierwhatyou'vedoneorhowbadthingshavegoien;whocangentlyguideyoubackontrack.Asmuchaswemayloveour'adult'childrenandwanttohelpthem,parentscannotfillthatroleataEmewhenourchildrenfeeltheyhave

'disappointed'usandwhenthey,naturally,wanttoestablishtheirindependenceandpullaway.

Sobrietyprogramsandmentalhealthprofessionalsgotmyson(andme)throughthecrisis–butwithoutNiteomywonderful,funny,

caringboywouldneverhavehadtheskillsorself-confidencetore-entertheworldasaresponsibleadultwithamission.

ThepeopleatNiteoweretrulymyson’sangels–andmine!”

“Oursonwasdiagnosedwithbipolardisorder4yearsagoandhadtodropoutof[college]aoerhisFreshmenyear.HewasenthusiasEcaboutaiending[college]andhadreceivedanacademicscholarship,butthedisorderwasunmanageableattheEme,andheneededhelp.MyhusbandandIjoined

NAMIFamilytoFamilyandgainedsupportandinsightintothementalhealthworld.WefoundanewdoctorforhimwhichhasbeenquitesuccessfulandwelearnedabouttheNiteoProgramatBU.MyhusbandandImetwithLarryandCourtneytomakesureitwouldbeagoodfitforourson.Weleothatofficewithtearsinoureyesbecauseweknewthisprogramwastoogoodtobetrue.Wewatchedhimregainhisconfidenceandbalancewithinhimselfoverthesemester.Hegainedfriendshipsandthestudentsgatheredoutsideoftheclassroomforsocialeventsthattheyplannedthemselves.WhenI

askedhimaboutthebenefittoparEcipaEngintheNiteoProgram,hetoldmethatitgavehimtheconfidencetogetbacktocollege.Oursoninformedusthathesignedupforacollegeclassthissummerandispayingforitonhis

own.Hehasheldajobfor4monthsnowandisdoingwell.ThisprogramhasgivenoursonhopeandthathopetranscendsthroughoutthisenPrefamily.WehavealwayshadfaithinoursonandhispotenEalbutwithouttheNiteoProgram,hewouldnothavetheconfidenceandself-esteemtomakehis

dreamsareality.”

ParentReports

StudentReports“IcametoNiteoasanalcoholicinearlyrecoveryconvinced

thingswereabouttogobad,liketheyalwaysdid,assoonasIgotreadytogobacktoschool.Iwasverymuchcertainthatnothing

couldconvincemeotherwise.ThroughNiteoclassesandcoaching,Icametobelievethatmylowself-worthand

unfortunateperspecEveonlifewereabletochange.CBT,meditaEon,andwriEngplayedaroleinthat.Thewayitprovidedstructure,theinstructors,thefriendlystaff,andtheresourcesat

thecenteritselfmadealargeimpactonme.AoerNiteo,Iaiended[college]inthespringof2015,takingjustoneclassbutworkingtwojobs,andgotaextremelyhighmark.NowIamtakingtwointensivesummercoursesat[college]andworking

twopartEmejobs.Ihavebeensober16monthsandamreadytogobacktoschoolfullEmeinthefall.Niteowasthebridgetothatgapbetweenlostandconfusedandhopefulandintune,Iwouldhighlyrecommendittoanyonethatbeganstrugglingaoerorshortlybeforetheywenttocollege.Theprogramhasthe

potenPaltosavelives,Ihaveseenitfirst-hand.”

StudentReports“Ihadrecentlytakenamedicalleaveofabsencefrom[college]andbecame

hospitalizedaoerleaving.WhenIwasreleasedfromthehospital,Ifeltunpreparedtoreturntoschoolaoerbeingoutandawayfromschoolforsuch

anextendedperiodofEme,leadingmetofindtheNITEOprogram.Thisprogramsuitedmeperfectly,asalloftheyoungadultstherewereinsimilar

situaEonsasIwas.ThisprogramhasenabledmetorealizethatIamnotaloneinmystrugglesandthatwiththehelpofsuchdedicatedstaffandpeers,Ican

returntoschoolfeelingconfidentanddetermined.NowthatNITEOhasendedIamworkingcloselywithmyone-on-onecoachtohelpfindmejobopportuniEesandalsotoresearchcollegesthatmightbesuitableformeinthenearfuture.Ihaveappliedtomanyworkplacesandamintheprocessoffindingwork

unElIfeelreadytoreturntoschool.IfNITEOhadnotbeenthereformeIwouldnothavehadtheopportunitytomeettheincrediblestaffandfellowstudentsthathelpedmeget

backuponmyfeet.NITEOandeverybodywhoworkstherehavebeensoincrediblykindandwillingtogoaboveandbeyondtoensureIreceivedtheservicesIneededtosucceed.ThisplaceistheonlyoneofitskindandforanybodywillingtoputtheEme

andworkintogepnghelp,itisforthem.”

StudentReports“IwasbroughttoNITEObymyneedforsomethingtopreparemetogetbackintocollege,aswellasstructureformydaysinthemeanEme.ThroughtheclassesandcoachingIlearnedavarietyofthingsfromhowtostructureanessaytomemoryskills,butIfeelthemostimportantlessonsIlearnedwerenotexplicitlypartofthecurriculum.Forexample,IlearnedthatIcouldsEll

socializewithpeers,somethingIhadnotdoneinawhile,andthatIamcapableofsipngthroughhoursofclasseswhilepayingaienEonandparEcipaEng.ThesetworevelaEonshavebeenhugeconfidenceboosters.Currently,Iam

searchingforavolunteerposiEonforthesummerandIplantoaiend[college]inthefallwhereIwillstudyintheveterinarytechnicianprogram.Inmy

personallife,IamsEllintouchwithpeersImetatNITEO.ThereisdefinitelyacorrelaEonbetweenmyparEcipaEoninNITEOclassesandthecoachingandwhereIamnow.WhatIlearnedgavemetheconfidencetoapplyto[college],andnowIhaveacollegeeducaEonaheadofme.IwouldcertainlyrecommendNITEOtoanotheryoungadultstrugglingwithwhattododuringtheirleaveofabsence.Ifeelthattheoverallexperiencewasbeneficialtonotonlyme,buttomanyofmypeersintheprogramaswellandsoitwouldlikelybehelpfulto

numerousotherpeople.”

BostonUniversity,SargentCollegeNewsleier,2015

ContactInformationCourtneyJoly-Lowdermilk,M.S.Edcjoly@bu.edu617-483-3827SarahSatgunam,LCSWssat@bu.edu617-483-3824DoriHutchinson,Sc.D.,CPRPdorih@bu.edu617-483-3826CenterforPsychiatricRehabilitaEonBostonUniversity940CommonwealthAvenueBoston,MA02215www.bu.edu/niteo NowaccepPngapplicaPonsforspring2016!