Issue 3 | Third Quarter | 2016 by Mary Christie Quarterly

Mary Christie Quarterly A publication of the Mary Christie Foundation

The Changing Landscape of Student Health and Wellness p. 15

Q&A with Phillip Satow, Founder of the Jed Foundation p. 04 Making the Employment Connection for Students with Disabilities p. 19

Issue 3 | Third Quarter | 2016

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. The foundation is a 501(c)3 nonprofit that depends on individuals and organizations to further its mission. You can support our mission by contacting Advancement Director Barbara Hickey at bhickey@marychristiefoundation.org

STAFF Publisher & President Editor & Executive Director Advancement Director Program Manager Communications Coordinator & Staff Writer

Robert Meenan Marjorie Malpiede Barbara Hickey Dana Baarsvik Ashira Morris

BOARD OF DIRECTORS Chair

John Sexton

Vice Chair

John P. Howe, III

Vice Chair

Michelle Dipp

President

Robert F. Meenan

Secretary

Marjorie Malpiede

Treasurer

Amy Feldman

Member

Frederick Chicos

COUNCIL OF EXPERTS Chair: Susan Windham-Bannister

Terry Fulmer

Lawrence Bacow

Dr. Paula Johnson

Lynne Bannister

Dr. Derri Shtasel

Grace Fey

Ellen Zane

CONTE NTS 04 Q&A: Phillip Satow 08 College Diabetes Network 13 Opinion: Ensuring Student Wellness Overseas 15 The Changing Landscape of Student Health and Wellness 19 Learning to Work 24 Opinion: A Report Card for the Affordable Care Act 27 Q&A: Stephanie Pinder-Amaker 31 Young Voices:Turning Grief into Empowerment 34 MCF Survey to Gauge Parent Views on Campus Drinking 36 Science Summary

Cover art by Emma Roulette Spot illustrations by Daniel Chang Christensen

Q&A: Phillip Satow The Jed Foundation founder proves that good things can happen when bad things happen to good people Interviewed By Marjorie Malpiede

In talking with Phillip Satow, it quickly becomes clear why the non-profit organization he founded in memory of his son has become the leading voice for suicide prevention on college campuses. Contemplative and articulate, Satow is one of those remarkable people that, when faced with a life-altering tragedy, creates something of great value to others. Even before The Jed Foundation became the standard-bearer for college mental health and suicide prevention, Phillip Satow had a distinguished profile as a business leader, philanthropist, and former college athlete from Columbia University. When his son, Jed, died by suicide while attending the University of Arizona, Satow and his wife, Donna, were determined to prevent other families from enduring the same unfathomable grief. Far from a sentimental gesture by a grieving father, however, The Jed Foundation has been a change agent for college mental health ever since its inception in 2000. Its comprehensive ap-

proach on how to comprehensively promote mental health and prevent suicide on college campuses has transformed the way colleges and universities address these issues. Now, 16 years later, The Jed Foundation is again setting precedent with a “boots on the ground” approach to making safe, healthy students an institutional priority for college administrators. Mary Christie Quarterly: What were your goals in founding The Jed Foundation? Phillip Satow: After we lost Jed, we visited the president at the University of Arizona who was very supportive and asked, “I have 35,000 students, what is it you’d like me to do?” We realized then we had no

answer, and our search to find the answer is what The Jed Foundation is all about. Donna and I thought a lot about what a university should do to prevent this kind of thing from happening, but back then, we really didn’t have a clue. We realized there wasn’t an organization focused on answering that question. We couldn’t do anything about Jed, but we thought, maybe we could prevent other families from feeling the devastation we felt. MCQ: What did you find when you asked college administrators, “What are you doing to prevent suicide?” PS: We often heard the same answer: “We have a counseling center and when students need it, they go there.” Many counseling centers, however, were severely limited in full time staff. Another real prob-

lem was that few universities were focused adequately on prevention. Suicide is the end of a continuum, and schools need to start at the beginning of that continuum. Preventing suicide is not only a question of appropriate treatment. It is a community issue that requires a public health mentality. One needs to be thinking about the college environment. Kids shouldn’t feel hopeless and alone. Friends need to be helping friends, and administrators, faculty, and gatekeepers on campus need to prioritize wellness. MCQ: How did you go about building out your mission? PS: I was the first to say, “I don’t know a lot about this area. Let me organize a panel of experts and gather the research. What are the problems? Where are the gaps?” I think this mindset was key for The Jed Foundation. Much of what The Jed Foundation does has been supported by published literature, outcomes data, and a model that has proven to be effective. We spoke with leaders at the American Psychiatric Association and other leading psychiatrists and experts in suicidology and college mental health. We realized that we could work with a small number of universities vertically – visit them, spend time with them, and make sure that they were doing the right things.

Alternatively, to improve our reach, we could develop a guiding model that included a set of policies to be effectively implemented, a model that could be applied to any college and university and be customized for their own campus culture. This is what we decided to do. In our research, we had come across a study in a British medical journal about how the Air Force had initiated a multi-faceted program that resulted in a significant reduction in suicides. It was particularly analogous to our efforts because the military is also a boundaried community.

change. It involves everything from having a 24-hour treatment service so, if a student has a psychotic break in the middle of the night, you have the capacity to respond; to developing medical leave policies that aren’t alienating and don’t discourage students from seeking help; to applying a means restriction strategy so that you eliminate things that can be dangerous to students. Are your roofs closed off? Do you need to change closet rods so they will break? If you can intervene at the moment people are considering suicide, they may never act.

We didn’t make our mission suicide. Suicide is the end of a continuum. We need to start at the beginning of that continuum.

In looking at what they had done, we saw it was a combination of both prevention and treatment activities. We adapted that model to serve college communities. That became The Jed Foundation model, which serves as our comprehensive approach to mental health promotion and suicide prevention. MCQ: Can you describe this approach? PS: The model is very inclusive and often requires behavioral

MCQ: How is all of this applied? PS: The Jed Campus Program is a four-year agreement with an individual school that starts with an assessment of a school’s policies, programs, and systems to find out what they have and what they need. What is the landscape for mental health on your campus? What are your gaps? We then work with them to

Photo by Mylan Torres

Phillip Satow discusses the origins and next steps for The Jed Foundation in his apartment in New York. Sixteen years after its founding, Satow continues to advocate for making safe, healthy students an institutional priority for college administrators

develop a strategic plan for mental wellness and substance abuse based on our model with representatives from all aspects of the university. This is The Jed Foundation safety net. MCQ: Was it difficult at first to get colleges and universities to engage with you? PS: Sadly, many of our early partners were schools that had experienced tragedy. Many college officials didn’t know what to do. But now we have over 200 institutions working with us who get that it’s about pre-

venting the tragedy. These are “Jed Campus schools.” A lot of our success at engagement is marketing. You need medical marketing programs because you can’t develop a marketing program without appropriate medical collaboration. We used PR and partnerships with groups like MTV and the Clinton Foundation to help spread the word. It is important to market wellness to students and other stakeholders to make it a way of life on campus.

MCQ: Have you seen a mindshift in how people are thinking about these issues? PS: We’ve seen a lot of progress. What we’re hoping is that fewer and fewer students will need treatment because of the public health programming that colleges are putting in place. That’s really prevention tied in with treatment. I think that’s one of the great things that The Jed Foundation brought to college health in general — and one of the things I’m most proud of —the appre-

ciation for the need for community prevention as well as appropriate treatment. MCQ: How has the Foundation changed? What is next?

can subsidize 17 schools. Now imagine those 17 schools in your state, and each has an average of 22,000 students. That’s 370,000 kids you are putting a

a safety net. I certainly don’t want students to be at risk on my campus. Tell me, campus executives, how do we make that happen here?”

PS: As we grew over time, we realized we could be even more effective if we could have a different relationship with the universities. If we could actually visit them and have boots on the ground, we could do this even better.

What we’re hoping is that fewer and fewer students will need treatment because of the public health programming that colleges are putting in place – and that’s really prevention tied in with treatment.

But my goodness, there are over 4,000 colleges. How big would our foundation need to be?

safety net under. How can you better spend your money?”

We’re still grappling with that question, but right now, we have four experts and five or six consultants who are visiting schools all over the country and working directly with practitioners on the model. We need more people in order to fulfill this next phase of our mission, so we’re actively fundraising in order to have the resources to work with more schools. One way we are hoping to fund this is by asking individuals, often alumni, to fund an on-site Jed Foundation partnership for, say, an entire state system. The response has been very promising. MCQ: So what is the pitch? PS: I would say, “Do you realize that for less than a dollar per student you can put a safety net under colleges in this country? For about $100,000, you

MCQ: What still needs to happen? PS: In my view, many college presidents are primarily focused on academics, prestige, and development. I would like to see more of them take this issue on in the way John Sexton did at NYU. It’s important that the leader of the university takes a strong stand on the kind of wellness experience students are having. One of the tenets of our strategic planning process is ensuring that someone from the president’s office be an active participant.

I’d love every college president to show this kind of interest in our mission. MCQ: Has the Jed Foundation answered the question the president asked you shortly after Jed’s death: “What can I do to prevent this from happening? We have a lot of work still to do, but at least we can say the following to any college or university: “If you do these things, you will see positive change.” For more information about The Jed Foundation, visit www.jedfoundation.org.

MCQ: Do you think college presidents are getting this message? PS: Over time, I think there are fewer and fewer who aren’t. If alerted, I think college presidents would say, “Yes, I want

College Diabetes Network For years, college students were overlooked within the diabetes community. Now, a peer-to-peer network is filling the void.

By Ashira Morris

When Christina Roth arrived on the UMass Amherst campus in the fall of 2007, there was no guide for how to be a college student with Type 1 diabetes. She was working with a new pump and struggling with burnout from the day-to-day management of her disease.

focused specifically on diabetes.

When she contracted Lyme disease, the health center connected her with a nurse who had been managing her own Type 1 diabetes for over 30 years and understood the challenges involved. In addition to treating her Lyme disease, the nurse talked to Roth about reaching out to others who were experiencing similar frustrations associated with Type 1 diabetes on campus.

But on campus, she was tired of feeling alone as a college student with diabetes. Through the nurse, Roth was able to get 11 students with Type 1 diabetes together for a meeting.

“All the students I see feel the exact same kind of burn out,” she told Roth. “They’re not in touch with anyone, but they want to be.” It was the first time since her diabetes diagnosis at age 14 that Roth was receptive to the idea of being a part of a group

“I’d never thought of myself as someone who wanted to connect with someone else with this disease,” she said. “I didn’t want that to be what connected me to somebody.”

“Coming out of it, I had this unbelievable sense of empowerment,” she said. “It was such a different way to look at diabetes and how I was motivated around it. It wasn’t this neg-

ative disease that I’m dealing with alone — they were going through the same things and felt the same way. We were able to laugh about living with diabetes. It was so freeing to be able to look at it in a different way.” Roth left that first meeting excited to spread the word. She set up a website for fellow UMass Amherst students with Type 1 diabetes to organize and meet up. Because this was the early days of the internet and there was a dearth of resources on managing diabetes as a college student, Roth’s page started getting hits from across the country. Anyone searching for “college” and “diabetes” saw the page as one of the top search results. Other students started reaching out to Roth, either to let her know about the chapters that they had started independently on their own campuses, to ask about how to get a chapter off the ground, or just to talk.

Photo by Brit Liggett

At the annual College Diabetes Network retreat in Maine, 25 CDN chapter members gathered to both stregnthen their individual chapters and foster friendships across chapters. “I’ve always felt a little odd because most people aren’t T1D,” said UC Merced’s chapter president, Alondra Zambrano, “As cheesy as it may sound, attending this retreat where almost everyone does, it felt normal. It made me feel at ease and appreciative of CDN and what we stand for.” This was the genesis of the College Diabetes Network, a national non-profit organization that now has 85 affiliated chapters spanning the country, with 30 in developing stages of affiliation. CDN is the leading peer-

to-peer support network for the over 50,000 American college students managing their diabetes on campus. “The young adults on college campuses don’t want to listen

to doctors,” Roth said. “They don’t want to listen to parents. They don’t want that top down approach. It’s an exploratory time about learning from each other and figuring it out.”

Diabetes Fact vs. Fiction Nearly 10 percent of the U.S. population has diabetes, but many common misconceptions remain. Here are the facts on a few diabetes fictions. Fiction: Type 1 and Type 2 diabetes are the same Facts: Type 1 diabetes is an autoimmune disease that causes beta cells in the pancreas (which make insulin) to stop working. Type 1 is hereditary and not caused by the diabetic’s actions. Type 2 diabetes, on the other hand, builds over time, usually as a result of sedentary habits and genetics. Type 2 occurs when the body is no longer able to make enough insulin to meet the body’s increasing needs. However, with both types of diabetes, the body can’t produce enough insulin, a hormone which turns sugar into energy. Without insulin, sugar builds up in the blood stream and the body’s cells have no way to transform the sugar into energy. Without insulin, the body is starved of resources.

Fiction: Having a pump means that your diabetes is cured Facts: Even with a pump, people with diabetes need to monitor and balance their insulin levels. Some people with Type 1 diabetes use a pump, while others may use a pen or a syringe. It depends on the individual and which tools work best for them. Fiction: People with Type 1 diabetes can’t drink alcohol Facts: While drinking is a personal choice and many people (with and without diabetes) choose not to, people with diabetes can drink alcohol. However, alcohol can affect blood glucose levels; the liver sees alcohol as a toxin that needs to be completely processed, and it will not release glucose into the blood until it’s done. It’s important for people who have diabetes to monitor their blood glucose levels both while drinking and after.

The Boston-based network provides an institutional backbone for the student-run chapters on campus; they are also a hub for information, resources, and support for young adults with diabetes. It allows chapters to provide whatever services best suit the community on campus. Most chapters hold meetings that give members the chance to have honest conversations about college life with diabetes. Others participate in diabetes activism or bring in speakers to talk to their members. The launch of CDN coincided with the first online communities where people talked about health issues, including diabetes. Roth didn’t market the network; it spread organically through word of mouth. In the early years, Roth knew what each of the organizations was up to. Now, there are so many chapters that she is mostly aware of what they do in aggregate. “It’s really nice,” she said, “because you can just step

back and see the ripple effect.” Dawgs for Diabetes, the University of Georgia chapter, puts on an annual off to college day that students and parents from across the state attend. In addition to providing practical information about managing diabetes on campus, the event also gives incoming students and their parents a chance to see other students with diabetes who are not only successful but also happy. Riley Jenkins, a rising junior at UGA and the incoming president of Dawgs for Diabetes, led tours for last year’s off to college day. “I really felt the positive impact it had on the high school students and their parents,” Jenkins said. “I wish I’d had this kind of tour when I was a rising freshman.” Even without a campus tour, all chapters provide a crucial passing down of institutional knowledge that didn’t exist before CDN. “Before CDN, it was a black hole for students coming on to campus,” Roth said. “So many

students with diabetes went through college, and they were all experts by the end. CDN harnesses the information from those self-practices and makes it accessible for students from the beginning. The combination of resources and support are making the process clearer and more transparent.” Across the country at the University of California Merced, the UC system’s newest school, Alondra Zambrano founded the CDN chapter United Pancreas last fall. She served as chapter president for the year and will continue leading the chapter through her senior year. “Before creating the CDN chapter, I was struggling,” Zambrano said. “It was already a difficult transition from high school to college, but it was especially difficult with diabetes. But being involved with CDN has made me more comfortable about being open about my diabetes. I’m grateful to be a part of CDN, and thankful for the whole CDN staff because my college experience wouldn’t be the way it is today without them.”

Helping students feel comfortable and open about their diabetes is one of CDN’s goals. Only about half of students surveyed by CDN and the Association on Higher Education and Disabilities registered for accommodations, like being able to eat during class or test blood glucose levels during an exam. Of the 46 percent who didn’t register, 68 percent wished they had. “At the campus level, talking about diabetes is a double edged sword,” Roth said. “You want to, on one end, show how normal you are and that there’s no need to discriminate. That you can do everything just as anyone else can, that diabetes does not limit who you are. On the other side, you want to be honest about how hard it is, that it is life and death, and that you’re using the only approved hormone that could kill you without doctor supervision. There’s this misconception with diabetes that you take insulin and you’re cured. It’s so much more complicated than that.”

“It wasn’t this negative disease that I’m dealing with alone — they were going through the same things and felt the same way. We were able to laugh about living with diabetes.” - Christina Roth, Founder & CEO, College Diabetes Network The answer, as always, lies in the middle. Which is where Roth found herself as she was finishing up her senior year, having applied for nonprofit status and waiting for someone with experience in nonprofits or foundations to pick it up.

the idea of the College Diabetes Network either. She worked an unofficial second job from 5 - 10 p.m. job running the network with Jo Treitman, a coworker and friend. They used their vacation time to attend conferences.

Roth didn’t have experience in business and, at the time, couldn’t envision herself as a CEO. But graduation rolled around in the spring of 2011, and no one had stepped up to run the network.

After a year, it was clear that working two full time jobs was too much. They set an ultimatum: if the network wasn’t off the ground in six months, they would figure something else out.

After graduating, she stuck to her original career plan, working as a research assistant at the Joslin Diabetes Center in one of the best endocrinology labs in the country, hoping to use the job as a stepping-stone to a PhD program.

In 2012, they quit their day jobs and went full time volunteer.

But she hadn’t given up on

“As someone who has lived through diabetes,” Roth said, “I felt so strongly that the peer aspect was what made it successful. I would not be able to have the same impact if I went into a

research career. Through CDN, we are able to take a more comprehensive and sustainable view of the challenges young adults face and work to solve them instead of just publishing on them.” Within the first six months, Novo Nordisk, a multinational pharmaceutical company that makes diabetes care products, gave them their first grant. Every year since, they have doubled in revenue and chapter size. Now, the network provides chapters with stipends and grants up to $500 to help them put on programming and hosts an annual retreat. This May, CDN won the 2016 New England Innovation Award by the Smaller Business Association of New England for their work improving the lives of college students with diabetes. Looking ahead, Roth is excited for the future of the organization. “We’re just getting started,” she said. To learn more about the College Diabetes Network, visit https://collegediabetesnetwork. org.

Opinion: Ensuring Student Wellness Overseas For students on international campuses, taking care of mental health presents unique challenges

By Ana Pereu jobs are the default for many university students, regardless of where in the world they are. More so, the ability or desire to take advantage of the global network of higher education — a network of globally dispersed campuses and sites that allow students to study and gain credit in different countries — brings a new dimension to students’ college experiences, among which is their emotional and mental health.

WE live in a time of acces-

sibility, opportunity, and interconnectedness. Our generation of students has more of an opportunity to take full advantage of the global education market that many universities have decided to join. Yet a decision to take such an opportunity might come with many strings attached, whether financial or emotional, which alter a student’s four-year college experience. Despite all these changes and opportunities, sleepless nights, overloaded schedules, pressure to succeed, and struggles to get top internships or

I am from Moldova in Eastern Europe, and in May of this year I graduated from New York University Abu Dhabi, one of NYU’s three portal campuses. As is the case at many other universities, depression is among the top struggles for a lot of students at NYU Abu Dhabi, often the product of homesickness, cultural shock, and for some, adjustment issues, demanding schedules, and dysfunctional relationships, among many other concerns. One of my friends describes the university as “a challenging environment, which represents a tremendous

jump from any high school workload.” A lot of students put pressure on themselves to be the best and to prove their abilities in a competitive environment where everyone else is equally, if not more, intelligent and talented. This can be quite draining. More so, students have to reconcile their desire to succeed with adjusting to a new country, to college life and in many cases, to a different educational system. Outside college campuses and alongside pressure from university life, college students and residents of the United Arab Emirates (UAE) might also struggle with meeting certain family expectations that are rooted in tradition and cultural values. Students might experience anxiety and stress if they can only live a restricted social life. Diabetes and obesity are also a continuing problem in the UAE, which generate body image issues and affect one’s self-esteem and inter-personal relations. All these have un-

doubtedly become sources of depression, anxiety, and other mental health issues for many students. Within the country, like in many other countries, there continues to be a stigma associated with discussing mental health issues. Unfortunately, across the globe, mental health issues are often equated with insanity. Fear of judgement and misunderstanding can affect one’s decision to seek formal and informal help.

that has set up counselling services for its students. Moreover, students themselves have organized support groups, events, and campaigns aimed at improving various aspects of wellness and wellbeing. Such platforms of student-to-student dialogue have helped normalize the discussion around mental health and have provided alternative coping mechanisms for those who cannot or are not ready to talk to a counsellor.

A friend who shared his perspective on mental health in the UAE with me describes another dimension of the situation: “These fears are also associated with a lack of belief in the very existence of mental health issues as opposed to the natural sciences, where cause and effect can actually be seen with the naked eye and quantified.” For those who are misinformed on the causes of mental health issues and ways of treatment, the inability to measure depression or anxiety leads to false conclusions that mental health issues are simply fabricated. Some hospitals have tried to address the issue by employing counsellors and psychiatrists, but their services are limited and many of them lack training in dealing with students specifically.

Nonetheless, there is still work to be done. One lingering problem is that the number of counsellors is disproportionate to the number of students seeking help. This understaffing can create further anxiety when students cannot get an appointment in a timely manner. While the university has taken steps to address the issue, employing more long-term counsellors has been difficult due to licensing processes. This is a problem since higher education institutions need counsellors who will be readily available for students. It is particularly important in the UAE, where we need counsellors to stay for a prolonged period of time in order to develop a strong rapport with students and continue to spread information about mental health issues.

NYU Abu Dhabi is one of the few education institutions in the region

In an effort to ensure the wellbeing of students, NYU Abu Dhabi has also

followed NYU New York’s footsteps in creating its own version of the Reality Show called the Real AD Show. This is an opportunity to come together with a group of students and create an original show that highlights the struggles that students at our university might be going through, including mental health and wellbeing issues. The goal of the show is clear: to open a dialogue very early on, to spread information about potential challenges that students will face and to ensure that no one feels alone. I was fortunate to be a member of the cast and contribute to the achievement of these goals. The first step to surpass the taboo surrounding mental health issues is to ensure that information is readily available and easily understood by the target audience. Education institutions the world-over need to disseminate better knowledge on these issues within their modes of formal education and generate conversations around mental health that are tailored to their particular contexts. Above all, they must ensure that no one is left out and no one feels alone and helpless with their struggles. Ana Pereu is a recent graduate of NYU Abu Dhabi and is currently studying International Relations and Politics at the University of Cambridge, in the UK. She is the 2016 recipient of the Mary Christie Fellowship Award for Academic Excellence and Leadership.

The Changing Landscape of Student Health and Wellness By Lawrence Bacow, President Emeritus, JD, MPP, PhD

IN THE five years since I command among our over- ing of their students. This inleft the presidency of Tufts all imperatives. Whether it is creased attention raises all University, much has changed higher expectations, increased sorts of questions both philorelative to student health and wellness starting with the higher priority these issues now

government scrutiny, or a new way of thinking, colleges and universities are being asked to do more to ensure the well-be-

sophical and practical. Like everything worth examining, the answers are complicated.

As a former university president, I have given considerable thought as to how the volume and complexity of student health and wellness issues have affected colleges generally and the role of the president, specifically.

have significant influence over many critical areas, including those that affect student health and wellness. And as overly presumptuous as it may be, presidents are the faces of their institutions in good times and in bad.

How well colleges and universities address student health and wellness affects every aspect of campus life.

First, I think it is important to note that there is a widely-held myth that college and university presidents have more authority than we actually do. This is academia after all, where consensus rules the day and lateral power structures discourage autocratic leadership. Iâ&#x20AC;&#x2122;ve often said that anyone on a college campus who tries to get something done by asserting their authority to do so has lost on day one. However, institutions of higher learning need strong leaders, and college presidents

As most parents (and neuroscientists) understand, 18-yearold college freshmen are not quite fully formed adults. Their brains are still developing. They frequently lack judgment, perspective and maturity. As a result, they often engage in unhealthy or even risky behavior whether it is eating poorly, not getting enough sleep, or experimenting with drugs or alcohol. And as we all know, temptations abound at most colleges and universities. In fact, you might argue that we try to educate students despite

the lifestyles they tend to lead in the four years they are on our campuses. The good news is that we now tend to take a more holistic view of student health. Issues that encompass student health and wellness have expanded to include physical health, mental health, substance abuse, suicide prevention, eating disorders and sexual assault. How well college and universities address these issues affects every aspect of campus life, from academic performance and admissions to freedom of speech and inclusion to litigation and public relations. Managing the growing array of student health issues is compounded by societal changes starting with increased public scrutiny. Society pays a lot more attention to higher education than it did in the past. Weâ&#x20AC;&#x2122;re in the news more and we are subject to more government intervention than ever before. Federal laws such as Title IX are important safeguards for women on campus who continue to be at-risk for

sexual assault; campus cultures with high rates of binge drinking increase that risk, making these areas in which we must continuously improve. But at the same time, we need to acknowledge the enormous and complicated set of requirements these laws impose on institutions that remain illequipped to adjudicate what are essentially allegations of criminal behavior. The proliferation of technology also has had an enormous impact on the capacity of college administrators to address controversies that in prior years might have been resolved with a few meetings among students. Social media has opened up our campuses so that no issue or dispute is likely to remain local for very long, and every conversation is a public conversation. Passions on campus are often inflamed by attention from outside groups with their own agendas. These groups often believe anything they read on the web, and are likely to have no tangible stake in the campus outcome. Their constant atten-

tion and scrutiny may keep the real stakeholders from having the hard conversations that are likely to produce mutual understanding. As anyone who has ever found themselves in the white heat of the media knows, generating consensus in such an environment is never easy. The coarseness of today’s public dialogue also exacerbates the problem. In academic settings where we ought to be debating issues on merit, and learning from our differences, we have groups calling each other names and engaging in behavior that is far from civil. I often say, “We need to model the behavior we hope to see in the rest of the world. If we can’t work these issues out on this beautiful campus with intelligent people who are neither starving nor scared, then there is no hope for the broader world.” Another important generational change is the capacity of students to communicate 24/7 with their

parents, again, fueled by technology. This constant communication encourages parental over-involvement that I believe is not in the long term interest of the student. I used to say to parents, “What we all want for our kids is grow up to be independent, to be able to live without us, but when we send them off to college and our natural inclination is to cling to them.” Our children will never learn to navigate bureaucracies or advocate for themselves if they are not tested by doing so on their own. Are students different? The science tells us yes in some ways. The drive for achievement is very high. There is far more focus on getting into the “right” school (thanks to US World and News Report) and not disappointing one’s parents. I also think the increase in the real cost of college has placed more pressure on students resulting in more stress-related illnesses. Part of it goes back to how

prepared students are for independence.

to others. Diversity works most of the time, but not always.”

I used to say to freshmen students upon matriculation, “You’re on your own now. We will do our part to take care of you but you must do yours as well. We expect you to be the type of person you described in your application. The Dean of Admissions assures me that none of you claimed to be loud, obnoxious, drunk or offensive to your neighbors.”

As administrators, parents, and students deal with the changing landscape of student health, there are some assumptions that are universally accepted while others are subject to a wide array of differing opinion. We all want our students to be healthy and safe; we all view college as a place for growth on many levels.

Some students seem very unprepared for the experiences they will encounter. Colleges and universities do not help by marketing themselves as utopian places where everyone succeeds. Nobody wants to say, “The truth is we have students here who struggle with identity, who feel isolated, who live with substance abuse or are hostile

Some institutions seek to cultivate life-long habits of fitness and health, both mental and physical. They are embracing a very broad view of their educational mission, one that some believe may be beyond their reach. Still other institutions, particularly those with fewer resources, continue to approach

Nobody wants to say, “The truth is we have students here who struggle with identity, who feel isolated, who live with substance abuse or are hostile to others. Diversity works most of the time, but not always.”

student health as a safety net; a place where illness and substance abuse are more likely to be treated than affirmatively prevented. In these institutions, the curriculum is more narrowly constructed and traditional academic achievement remains the primary goal. It seems to me that the critical question for college presidents today, at least for those at four year institutions with involved parents, is to determine the appropriate compact between parents, students and institution. What reasonable expectations do each of the parties hold for the other? What responsibilities are each expected to accept? Colleges and universities will need to examine these questions and college presidents will need to communicate the answers. Lawrence Bacow is a former President of Tufts University and former Chancellor of MIT, and as of May 2011, serves as a member of the Harvard Corporation, the fiduciary body of Harvard University.

Learning to Work The supply of college graduates with disabilities is high, as is the demand from diversity-driven employers. Why aren’t more of these students getting jobs?

By Marjorie Malpiede AS colleges and universi- ficiency for the 29 million students in preparing for and ties continue to promote their working- aged Americans with gaining employment, lacked a job placement rates, there is one employment statistic few schools are talking about: the percentage of their graduates with disabilities who enter the work force. Despite the rising number of students with disabilities who graduate college, those who report to be working remains at around 40 percent. Carol Glazer, the President of the National Organization on Disability (NOD), believes the poor job placement of students with disabilities is not only a social justice failure, but also a lost opportunity to address the talent needs of today’s employers. NOD has recently formed a partnership with Career Opportunities for Students with Disabilities (COSD) aimed at changing these employment statistics with an agenda that is as focused on market demand as it is on diversity. For 30 years, NOD has been striving to increase job opportunities and economic self-suf-

disabilities. Much of their work involves connecting employers seeking to expand their diversity initiatives with work-ready candidates. For employers hoping to hire graduates with disabilities, the challenge has been particularly tough.

“We have employers tell us all the time they just can’t find students with disabilities,” said Glazer. “They will go out and have job fairs and find various minority segments but when it comes to students with disabilities, they get them in ones and twos. They say it is hard to find students who are well-prepared to enter their work force.” A logical source for these recruiters would be college and university career offices but, according to Glazer, this is part of the problem. In its 2014 report “Bridging the Employment Gap for Students with Disabilities,” NOD found that at many schools, the career services office, which assists

connection to the office of disabled student services, which exists with the purpose of ensuring proper accessibility and appropriate academic accommodations for students with disabilities on campus. “This disconnect leaves a gap,” the report states, “both for employers seeking to diversify their work force and for students with disabilities who are not gaining access to the same services and opportunities as their peers without disabilities.” As NOD sought expert advice in this area, all roads led to Alan Muir of COSD, who has been working on solving the access problem for the last 17 years. The organization grew out of research at the University of Tennessee that first identified operational and philosophical disconnects between the offices of career services and disability services as a major barrier to

post-graduate employment for students with disabilities. What began as a small grant at one college has become a national effort to work directly with colleges and universities on a wide range of strategies that seek to better prepare stu-

among key stakeholders and panel discussions on preparing students for employment as well as how best to reach them. The two-day conference is upbeat and pro-active but, as these advocates know, the obstacles in this area remain challenging and include every-

503 means that employers can no longer satisfy diversity criteria by hiring individuals with disabilities for the loading dock or mail room.

dents with disabilities for careers. COSD has developed a network that has grown to over 900 higher education institutions and nearly 600 employers. The NOD/COSD partnership has yielded some early successes including an annual conference that brings together employers, schools, and students. This effort to address both sides of the labor force equation includes on-site networking

thing from lack of coordination to stigma and confidentiality issues to entrenched attitudes regarding workers with disabilities. High supply, high demand The National Center on Educational Statistics estimated that in 2011, 11.1 percent of the number of college students on campus have disclosed one or more disabilities and are receiving services from Disability Services. That translates to 1.5

million students. With so many students not disclosing non-apparent disabilities, that number is almost two times higher. In 2008, the ADA Amendments Act reinstated protections for people with all kinds of disabilities, which had been eroded due to multiple judicial interpretations. These disabilities include â&#x20AC;&#x153;invisibleâ&#x20AC;? disabilities such as dyslexia, anxiety disorders, ADHD, and autism spectrum disorders. This amended legislation significantly expands the population of students with disabilities and adds another layer of diversity to an already heterogeneous cohort. Meanwhile, the motivation for hiring graduates with any of these disabilities has never been greater. In 2014, the Obama administration enacted new rules for Section 503 of the Rehabilitation Act, requiring employers receiving government contracts to set a 7 percent disabilities goal across all positions, not just those requiring low skills and limited education. This means that employers can no longer satisfy diversity

criteria by hiring individuals with disabilities for the loading dock or mail room. According to Glazer, they mean business. “Corporate America understands that 503 is here and that they need to focus on this,” she said. “The Office of Federal Contract Compliance is not fooling around. They are monitoring businesses, and they will start imposing fines.” Considering that federal contracting constitutes 25 percent of the nation’s workforce, 503 may do for disability employment what Sarbanes Oxley did for the auditing industry. As Glazer and Muir work aggressively to help businesses achieve both the requirements and the promise of 503, they are helping their partners in higher education eliminate some of the institutional barriers that have kept all parties back. This starts with creating an on-campus employment support system out of what has always been two separate sets of resources. On one hand, career services professionals are well skilled at preparing students for inter-

Photo by Huntstock/ disabilityimages.com

views and developing resumes but lack the disability knowledge and capacity to assist companies that want to recruit these students. They also lack

the appropriate training and skills to assist students with disabilities in their career development efforts.

University disability offices that do have the skills to assist students with their careers are often short-staffed and primary focused on the accessibility and accommodations students need to complete their education.

“I don’t think that student affairs administrators have figured out that there is a definite intersection between these two offices and for decades,” Muir said. “We’ve had students falling through the cracks. We

need to make sure that both offices are being supported and are educated about the new regulations.” Muir says his goal has been to push through this by encouraging students with disabilities to access the career services resources that are available to them and to let the disability officers know that their responsibility goes well beyond graduation. Confidentiality, information, and disclosure

Co-presented by

The premier educational and networking forum to learn about leading practices in preparation, recruitment, and hiring of college students and recent graduates with disabilities. November 17, 2016 · 10 AM - 5 PM · Hyatt Regency · Cambridge, MA To register, email events@NOD.org

Some say the issue on campus is far more than just a lack of coordination or relevant skills. Historically, students with disabilities looking for jobs were encouraged to hide their disabilities from their potential employers. Stigma surrounding mental health disabilities continues to dissuade many students with disabilities from disclosing them. Furthermore, NOD notes “career services professionals may feel it is unfair or even illegal to try to identify or serve in a special way students with disabilities, since they are bound by

confidentiality rules to protect disability-related information.” The confluence of these issues is problematic on a number of levels: it keeps students from getting the career support they — and their peers without disabilities— need to gain employment; it renders them invisible to would-be employers who are specifically seeking graduates with disabilities; and it keeps colleges and universities from gathering the information that would allow them to measure students’ progress over time and implement data bases that could be used by employers. Glazer believes colleges have a responsibility to encourage more students to disclose their disability by communicating the opportunities available to them. “Instead of telling your students not to disclose,” she said, “you should be telling them they will be desirable, employers will make accommodations for them, and they will be valued members of the team.” Glazer is also concerned that underlying all of this is a univer-

sal lack of acknowledgement that students with disabilities are as capable and deserving of employment as any student, something she calls “the tyranny of low expectations.” “If you are a college student with disabilities,” she said, “we should be preparing you and training you the way we do all students, and it should probably start back in high school. But instead, we congratulate you for having made it into college and we don’t expect that you should have to — or can — go on to work. When people don’t expect much of you your whole life, you begin not to expect much of yourself.” But both Glazer and Muir are encouraged that, with the stars aligned on more graduates with disabilities entering the workforce, major change will occur. The partnership recommends a series of practical steps to building a robust pipeline of students that can be accessed by employers.

specifically with the disabilities office; creating a voluntary release form for students to sign when registering with the disability office that gives permission to share the student’s name with the career services office; encouraging recruiters to have an on-campus presence and identify themselves as “disability-friendly;” and supporting co-ops and internships specifically for students with disabilities. Other efforts are aimed at greater engagement on the part of the students themselves and increased education about the value of colleges making this an institutional priority. “Students with disabilities who find fulfilling positions have proven to be loyal employees as well as grateful alumni,” said Muir. “The schools who get this will have an enormous advantage in meeting many of their goals, including the need to educate and prepare all of their students for success.”

These include: appointing a liaison from the career services office who is specially trained in the needs of students to work

Opinion: A Report Card for the Affordable Care Act An assessment six years into America’s grand health insurance experiment

By John W. Rowe

SINCE ITS ENACTMENT on March 23, 2010, the Af-

fordable Care Act (ACA) has been frequently modified. There have been over 70 changes so far, including administrative and legislative measures as well as the changes ordered by the Supreme Court, such as making Medicaid expansion voluntary. The ACA has been subject to ceaseless repeal efforts as well as daily headlines screaming praise or hatred. While it is too soon to say what the ultimate effect of the law will be, some hard facts and in-

teresting trends are emerging. As is often the case, many of the rosy promises and dire predictions have failed to materialize.

Medicaid despite the federal government’s commitment to cover the costs in the early years.

First, the ACA has been effective in reaching its primary goal to reduce the number of uninsured, which has fallen by about 20 million — from 18.2 percent of the US population in 2010 to 10.5 percent in 2015. This was accomplished through a mandate for individuals to obtain coverage, a mandate for employers to offer coverage, Medicaid expansion in many states, and the extension of coverage for young adults until age 26 under their parents’ plans.

The law introduced several specific changes in insurance practice, including mandatory review of rate increases over 10 percent, elimination of lifetime and annual limits and restrictions based on pre-existing conditions, and a minimum medical loss ratio, which is the proportion of collected premiums paid out in claims. In addition to these practice changes, new taxes and fees were levied on insurers to help pay for some of the costs of the subsidies in the new exchanges. The insurance industry resisted many of these changes, and there was a loud chorus of Cassandras predicting that insurers would fail, which didn’t happen.

Nonetheless, many price-sensitive individuals continue to choose to remain uninsured and pay a penalty rather than pay what they believe is too high a premium. This includes individuals for whom the government is picking up most of the tab through subsidies. Also, it is important to remember that many states, especially in the South, have not expanded

In general, insurers had surprisingly little difficulty adapting to the new world, as corporate profits and share prices have been fine in most cases. Here again, many chang-

es were made as the program evolved, including the decision to permit individuals to remain in some â&#x20AC;&#x153;mini-med,â&#x20AC;? low value plans to continue with that coverage, despite the initial plan to eliminate such low actuarial value offerings. The establishment of the new public exchanges, administered by either the states or the federal government on behalf of states, has been a topic of extreme interest and innumerable analyses and media reports. Things got off to an awful start as the on-line enrollment system crashed at the outset, but the government recovered and a reasonable numbers of individuals enrolled. One major initial concern was that employers would send vast numbers of their employees to the exchanges, thus ruining the commercial, employer-sponsored market did not come to pass. Employers are generally not discontinuing their coverage and sending large numbers of individuals to the exchanges. Another major concern was that inadequate numbers of plans would be offered and people would not have choice. To mitigate this potential risk, the government established a couple dozen co-ops in certain markets to assure that choice was available. So far, this prediction has also not panned out. Substantial numbers of plans have been offered and almost all markets have substantial choice.

Many new insurance plans have been established in response to the emergence of this new exchange marketplace. It is notable that a substantial number of these insurance plans are sponsored by providers, hospitals, regional health systems, or large physician groups. This trend toward provider sponsorship represents an interesting shift of risk from traditional insurers to providers and time will tell how it plays out. Much attention has been paid to the fact that some insurers have failed, including several

against because of the federal governmentâ&#x20AC;&#x2122;s reinsurance and risk corridors programs. These programs promised to protect the companies to some extent from the ill effects of potential adverse risk selection or the enrollment of too many sick people and not enough healthy ones. This seemed a reasonable bet at first, but one of the changes Congress made was to require that the risk corridor program be net neutral, meaning that the amount to be distributed to the plans that lost money due to bad experience was limited

As is often the case, many of the rosy promises and dire predictions have failed to materialize.

high-profile debacles amongst the co-ops. Several factors are at play here: To begin with, health insurance is a risky business, and it has always been true that many new companies that did not have the financial strength to ride out a storm failed before the ACA was enacted.

to the amount that was paid in to the government by the plans that had favorable financial experience. Since many more plans lost money than made money, the amount available for distribution to the losers was far less than initially expected.

Secondly, in addition to being under-capitalized, many new companies are often too aggressive in their efforts to grab market share, and their underpricing comes back to haunt them. In the case of the public exchanges, many new plans felt they were protected

Why did so many plans lose money? Part of the problem was underpricing, but part was also that the overall utilization of the enrollees was greater than expected and the government came up with far less loss-reduction funding than was initially expected.

As for the degree of health care utilization experienced to date, initially it appeared that the populations that enrolled in the exchanges included a reasonable mix of healthy and sick folks and that the markets would work, even without the support of the federal plans to prop up the markets by backstopping some of the risk. Over the past year, however, more plans have lost money and large insurers, who offer plans in many markets, have announced that they would reduce or eliminate their participation. United Health Group was the first large player to do so, and now Aetna has made a similar announcement. Opponents of the ACA have pounced on this news as evidence that the exchanges are flawed and about to enter a death spiral as pre-

miums rise to cover losses and healthy patients flee, leaving a smaller core of higher cost members. In my view, these predictions of the demise of the exchanges are premature. The facts show that the year-over-year average increases in premiums, and while theyâ&#x20AC;&#x2122;re higher for 2017 than they were in 2016, they are still not as high as the preACA individual market premium increases. The final information for 2017 will not be available for a while, but at this early date it appears an exchange offering will be available essentially everywhere. Most people will have several options to choose from, though the withdrawals and failures indicate that as many as 17 percent of the population may be in exchanges with only one plan offering.

The limitation of choice relates to providers as well as plans since many of the plans that are staying in the exchanges are adopting narrow networks with limited choices of hospitals and physicians than the previous broader networks. The government is betting that the market will stabilize. I think they may be right, but they should also be ready to provide more support for the payers, if needed. Weâ&#x20AC;&#x2122;ll know much more this time next year. John W. Rowe is the former Chairman and CEO of Aetna, Inc., the former President of the Mount Sinai Hospital and the Mount Sinai School of Medicine in New York City. He is currently the Julius B. Richmond Professor of Health Policy and Aging at the Columbia University Mailman School of Public Health

Q&A: Stephanie Pinder-Amaker The founding director of McLean’s College Mental Health program helps schools see the value of a student-centered approach Interviewed By Marjorie Malpiede Driving onto the McLean hospital grounds in Belmont Massachusetts is like entering an iconic college campus, right down to the leafy green lawns, matching brick buildings, and challenging signage. Here, Stephanie Pinder-Amaker, Ph.D, directs McLean’s College Mental Health Program, the nation’s only comprehensive program for college mental health that combines treatment, research, and outreach.

— but we don’t know higher education. We don’t know what’s happening on college campuses.”

A clinical psychologist and former student affairs professional, Pinder-Amaker came to McLean from the University of Michigan where she led a number of pioneering efforts in student mental health and crisis response. When McLean’s President, Scott Rauch, asked if she’d be interested in starting a college mental health program at what is considered the top freestanding psychiatric hospital in the world, she found his argument particularly compelling.

Mary Christie Quarterly: How did the College Mental Health Program get started?

“We have the expertise — the world class clinicians across all the presenting clinical concerns

As the program’s founding director, Pinder-Amaker puts her experience at Michigan to work on behalf of hundreds of college students and the institutions they attend, all the time keeping a close watch on what’s really going on at schools across the country.

Stephanie Pinder Amaker: There was a growing sense, anecdotally, that we were seeing an increase in our college student presence throughout the hospital, but we didn’t have the data. This was hard to do since we were seeing so many kids coming in for treatment through different access points, such as through the Obsessive

Compulsive Disorder Institute and through the Klarman Eating Disorders Center. We had students coming in at all levels of care, from day programming to intensive two-week experiences. We needed to have an accurate picture of who we were treating, so goal number one was to gather data. When we were better able to quantify our work, we really saw that we had a microcosm of what’s happening nationally in terms of student mental health. I think with that came a mandate to do this work in conjunction with colleges. We had this unique opportunity to learn as much as we could about the kinds of concerns college students are presented with. We spent a lot of time reaching out to the higher education community: visiting campuses, meeting with mental health providers and campus administrators, and sharing and learning

what’s working. All of that early work led to the development of our three domains of work: trans-diagnostic student focused treatment, outreach and consultation with colleges and universities, and continued research. This way, we are treating kids, helping practitioners on campus, and contributing to the field of student mental health. MCQ: How did your experiences at Michigan prepare you for this role? SPA: Michigan, as most people know, is a very progressive campus when it comes to student affairs issues. They were proactive on issues like LGBTQ rights, multi-cultural concerns, sexual assault, and suicide prevention way before other institutions were. They made mental health a huge priority. I feel really fortunate that when I first became immersed in college student mental health, it was in a place that was at the far end of the continuum. Early on, they were saying, “These kids are ours. We want to know what their concerns are and when they get here, we’re going to do our level best to keep them here. Period.” But I think the most important thing I learned from doing that work is the need to get out ahead of some of these things and to have the time and the space to think about preven-

tion strategically. It’s very hard. You see schools over and over again getting caught in this vicious cycle where they’re in the business of responding to one crisis after another. That approach isn’t an effective resolution over time, but it’s hard for schools to break that cycle. MCQ: How do you schools with this?

help

SPA: Sometimes the consultations we do are about policy, like redesigning an effective emergency mental health readmissions policy, but we most often get hired to work with schools in response to critical incidents. It is rewarding to go in during a crisis period when you have everyone’s attention and they keep asking how they can help, but if a school wants our program to help them with

to trauma where we literally set up shop on campus. That’s the short-term piece. But the long-term commitment is continuing to consult with their clinical psychological services to figure out where the gaps are — the clinical interventions and expertise they are missing to prevent and respond to trauma. MCQ: What are you seeing, in terms of trends in student mental health? SPA: An increase in students arriving on campus with more severe and complex mental health concerns. That’s a pretty well-documented trend at this point. There is a larger number of students already taking psychotropic medications and a burgeoning number of stu-

We saw that we had a microcosm of what’s happening nationally right here in terms of student mental health. I think with that came a mandate to do this work.

a short-term crisis, we require them to commit to developing a long-term solution as well. For example, we might get asked to come in to respond to a crisis like a sexual assault on campus that can be triggering for everyone, including faculty. We would provide emergency clinical resources responding

dents arriving with functioning autism disorders. This is a result of early identification and intervention; these are all positive things. Perceived stigma is down, but self-stigma is as much a problem as it has always been. In other words, if your roommate takes medication for depres-

sion, you are not going to think any less of him or her. But if you have depression, you’re going to think less of yourself. There is a reluctance to define oneself as having an illness and this gets in the way of a lot of kids seeking help. Help-seeking behavior remains a Catch 22 for colleges. Campuses can’t keep up with the growing demand for mental health services, but at the same time, students’ help-seeking behavior is still really conservative. Nearly 75 percent of students who need services won’t seek them through traditional portals on campus. Schools are asking themselves, “How do we better reach that 75 percent?” but, at the same time, they’re also asking, “What do we do if we reach them all?” MCQ: Is this where the community partnerships come into play? SPA: Yes. Community partnerships are really important. They’re essential because we know campus services have limited capacity, and so many students need more support or longer-term care. Some schools do a really good job at getting to know and engaging with partners, while others just keep referral lists that may or may not be updated.

it’s on you to understand what unique needs or concerns this student/patient may have.

Community providers have to do a better job at this as well. We need to meet the schools halfway. If you are a practitioner working with students,

For example, if you are working with an MIT student who happens to be an international student, it’s important to understand what additional re-

Photo by John Gillooly

Stephanie Pinder-Amaker in her office at McLean Hospital. Dr. Pinder-Amaker is the founding director of the hospital’s CollegeMental Health program. courses MIT has for supporting this person. Having a campus/community liaison can be a great resource here on many levels. The liaison can keep the communication going and can really support students. You may be

living on campus and going into the community for weekly therapy. You may be going to yet another place for medical management. It can be very hard to navigate all of this. MCQ: How are colleges improving in this area? What still needs to happen? SPA: I am really pleased to see that more schools are engaging in comprehensive assessments of the mental health functioning of their incoming students as a way of understanding who is about to come to them, as well as what their needs may be. The schools then use that information to inform programming and link students up with key resources before they even arrive on campus. These colleges are saying, “One in four of our students is going to have a mental health challenge while they’re with us. We need to be proactive about identifying them, reaching out to them, and supporting them.”

It is a completely different philosophy than saying, “We’re not going to have those problems here.” Another approach we’re working on is to reach younger students — secondary school at the latest —and do more engaging with their psychiatrists, their parents, and their high schools around preparation for college and the college transition. MCQ: What is your opinion on the current role of parents? SPA: This is an important strategic area for us. The under-tapped stakeholder in all of this is the parent of the student in crisis. Schools and providers have to do a better job of communicating and engaging these parents, especially since many of them are in a position to provide additional support. Often, the first people a student will invite to their college support team will be their par-

ents, even if they are across the country. But too often, parents of students in crisis are desperate, under-resourced, and under-served. They are in a tough place because they are essentially cut out of the communication loop. MCQ: Is this due to the confidentiality policies? What is your take on that? SPA: My bias is to engage students early and often around the benefits of permitting communication, and not just with parents. We work with students on the advantages of selected disclosure so they can widen their support circle. Obviously, this is hard for kids. No one wants his or her problems shared with the world — that’s understandable. We advise kids to reach out to someone who is in a position to help them by knowing their situation. The healthiest way to do this is to remind kids that they get to decide who to tell and how to tell them.

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Young Voices: Turning Grief into Empowerment The story behind Tell Me About Your Day

By Isabel Lloyd I’M AN ENGINEERING student at MIT. I have an

engineering mindset, so when I see a problem, I want to fix it. The problem that I am personally motivated to take on is suicide. After coping with two friends’ suicides, both personally and as a part of the broader MIT community, I came up with Tell Me About Your Day (TMAYD) to physically show people that they are cared for and to and to help de-stigmatize of mental health across the world. I learned how it feels to lose someone to suicide when I was 15 years old. My freshman year of high school, I was on the women’s swim team. We were a group of 10 girls who weren’t particularly good at swimming, but we had fun. Our leader was Coach Bob. He was a tall, farm-loving man who was too tan for his own good. He was nice and fun, but scary as hell during a race. I used to call him Coach Bobby —

Photo by Maia Weinstock

Author Isabel Lloyd hugs a fellow MIT student after having a conversation prompted by the Tell Me About Your Day wristbands she created. nothing ground his gears more than being called Bobby. Coach Bob took his life in the middle of our season.

At that point in my life, I felt the sadness of losing someone. I had lost my grandpa before losing Coach Bob, and I was sad

just like that. Only the sadness was accompanied by so much that I didn’t understand. When I lost someone to a disease it felt complete. When I lost someone to suicide it did not. My freshman year of college, I was in a Media Arts and Sciences class with another freshman named Matthew. For one assignment, he wrote an essay about how awesome laundry machines are. I was amazed at how he dove head first into details about something as mundane as laundry. Matthew and I lived in the same dorm, so we saw each other around quite a bit. One night, I was walking home after an a cappella competition. I was dressed up because we performed and annoyed because we didn’t place. Matthew and I crossed paths, and he told me I looked nice. I made fun of him for wearing a trench coat. I found out the next morning that he committed suicide just a little while after we had spoken. That same year, I took differential equations. It was the hardest math class I had ever taken. The one good thing about the class was Christina. We sat next to each other, and whenever I would get bored, I would reach over and draw something on her notes page. I am terrible at drawing, so she would laugh and then quickly tell me to pay attention.

One day, Christina didn’t show up for recitation. Then days turned into weeks. When I asked around I found out she had Postural Orthostatic Tachycardia Syndrome (POTS), a form of Dysautonomia, and had gone home to get treatment. I was sitting in the lobby of Christina’s dorm when I found out she had taken her life after fighting an impossibly uphill battle against her own body. Losing Matthew and Christina crushed me. I didn’t leave my bed for a week, and I couldn’t sleep more than an hour each night. I think I was mostly in a state of shock because I don’t remember a lot of what went

think I can identify an exact reason for why I was under this impression, but I do know I am not the only one who views therapy this way. Mental health, and seeking help for your mental health, is so stigmatized in our society that many are led to believe that it is only a resource for when you are about to explode. During my trip to MIT Mental Health, I realized this wasn’t the case. I had another realization during this trying time: everyone around me was caring for each other all of a sudden. It seemed like everywhere I looked — email, social media,

When I lost someone to a disease it felt complete. When I lost someone to suicide it did not.

on in my head. I just know I couldn’t do anything. Eventually, people noticed that I wasn’t in my usual routine, so one of my sorority sisters went with me to the mental health clinic. It felt horrible going to MIT Mental Health. I always thought that if you went to therapy, you were broken; you gave up on fixing yourself, so you needed someone else to do it. I don’t

in person — the people around me were reaching out to one another in support. The most compelling part of these connections was that the people around me were offering their support to anyone who needed it, including strangers. I loved seeing that so much, but it really frustrated me that everyone waited until my friends took their own lives to show their care.

My two realizations got me thinking: how might we de-stigmatize mental health in our society, and how might we show that people care about one another without waiting for tragedy to bring it out? Thinking about these questions led to the creation of Tell Me About Your Day. I wanted to help show everyone that they are supported and cared about by the people around them, though it may not always be shown. I also wanted to get everyone on board with the idea that mental health isn’t an untouchable subject. We should

all stand together in support of those struggling with mental health issues. I made wristbands with the acronym TMAYD and spread the message that anyone wearing a wristband is saying that he or she cares. The wristbands are a way of showing support for others all the time, throughout every part of the day. This visible, hard-to-ignore community of supporters is helping to spread a truly powerful message that has helped my college community grow stronger than ever before.

My name is Izzy. I am 19 years old, and I am originally from Kansas. I am in an a cappella group and a sorority at MIT, where I study mechanical engineering and product design. I love my cat Jackson. One of my biggest passions is mental health and suicide prevention, and my biggest mission right now is to lower the suicide rate as much as one person possibly can.

MCF Presidents’ Colloquium on Student Health and Wellness

This November, the Mary Christie Foundation will host the MCF Presidents’ Colloquium on Student Health and Wellness, a two-day event in New York City designed for college and university presidents to share knowledge and produce new thinking on the expanding array of issues that make up student health and wellness.

MCF Survey to Gauge Parent Views on Campus Drinking Findings to help address the ongoing issue.

By Steve Koczela and Rich Parr the University of Maryland’s School of Public Health Knowing what parents know – and think -- about campus drinking may help administrators in their ongoing addressment of this problem.

Steve Koczela, MassINC Polling Group President

The answers to these questions may be critical to their students’ entire academic experience.

This September, the Mary Christie Foundation, the Hazelden Betty Ford Institute for Recovery Advocacy, and The MassINC Polling Group will work together to conduct a national survey of parents of college students about campus alcohol use and prevention policies. We want to understand from parents how much drinking they think is happening on college campuses and how much of a problem they think it is.

“Excessive drinking among college students is still a serious public health problem, and can be an obstacle for students who are trying to succeed both personally and academically,” said Dr. Amelia Arria, Director of the Center on Young Adult Health and Development at

Do parents see, for instance, a connection between drinking and academic problems, or negative or dangerous behavior? Do they think the problem is better or worse than when they were at school? We also want to understand how aware parents are of what colleges are doing

Rich Parr, MassINC Polling Group Research Director

FALL IS back-to-school they hearing from college adseason, when parents drop ministrators? their children off at college campuses across the country. The experience brings a unique mix of parental anticipation and anxiety, as the opportunities of college mingle with the concerns about letting go.

But while parents are understandably anxious about many parts of the college experience, where does alcohol rank? How much do they know about drinking on campus? What are

to address problem drinking on campus. Are they aware, for instance, of the disciplinary code at their child’s school? Have they received communications about alcohol abuse on campus from the administration? Do they think that their child’s school is doing enough to address the problem? Our hope is that this research into parents’ opinions will complement the impressive body of work on other aspects of campus drinking. We see parental knowledge and opinion as one leg of a stool, alongside research into student behavior and attitudes, and studies on what colleges are doing and how effective their policies seem to be. The National Institute on Alcohol Abuse and Alcoholism has led efforts to collect data on these second and third legs. Their College Alcohol Intervention Matrix (CollegeAIM) rates 60 different policies aimed at individual students or the campus environment based on factors like effectiveness, ease of implementation, and cost, making it easy for college administrators to see how their current plans stack up and make changes that fit their circumstances and budget.

Of course, every college campus is different, with different cultures and institutions driving alcohol use and prevention. CollegeAIM advises administrators to take those differences into consideration: “The first step for effective intervention programming is to understand the nature of alcohol-related problems on your campus and answer the question, ‘What do we need to focus on now?’ Consider how alcohol problems manifest themselves at your school. What do they look like? For example, are there problems with your Greek system? In your first-year residence halls? In off-campus student housing? Are there issues related to retail establishments in your neighborhood? Are there fights and vandalism at your school’s athletic events? Do most problems occur at certain times of day or on certain days of the week? In short, what are the times, places, and subgroups that give rise to alcohol-related harm?”

they wish they had? How do the expectations of parents at, say, a large state school with an active Greek system differ from those sending their kids to small liberal arts colleges? And, perhaps most importantly, do those expectations align with the reality of alcohol use and abuse on those respective campuses? We are currently working with the staff from the Mary Christie Foundation to create survey questions, which we will then distribute to a national sample of parents of college students. We hope to have results to report in time for the next edition of the Mary Christie Quarterly. We look forward to sharing what we find. Steve Koczela is is the President of The MassINC Polling Group. His writing and analysis appears at WBUR, NHPR, CommonWealth Magazine, and elsewhere. Rich Parr is Research Director with The MassINC Polling Group and runs MPG’s office in Western Massachusetts. He co-authors pieces for WBUR, NHPR, and CommonWealth magazine.

The same goes for parents. Are they aware of the culture of drinking on their students’ campuses, and how it might differ from other schools? Was that something they considered when deciding on a school? Do

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

A new report by the Education Trust reveals that in 2013, roughly 3.6 percent of colleges and universities â&#x20AC;&#x201D; which equates to 138 schools â&#x20AC;&#x201D; held 75 percent of all endowment wealth, each holding at least half-a-billion dollars in endowment assets. Despite these large endowments, few of them invested a significant amount in students from low-income families. Nearly half are in the bottom 5 percent nationally for their enrollment of first-time, full-time Pell Grant recipients, and four out of five of these schools have a tuition for low income students that exceeds 60 percent of family income. Endowment funds are tax exempt, but these colleges are not bound by the same 5 percent annual spending requirement to which other private foundations are bound.

Institutional Wealth and Low Income Students

In its examination, The Education Trust found that more than half of these schools are spending endowment assets at less than 5 percent. The report suggests that if the colleges spending below 5 percent were to increase their spending rates to that required by other private foundations, they would generate an extra $418 million in funding that could be used on financial aid. The study goes on to suggest that an infusion of funds such as this would allow these schools to enroll an additional 2,376 low-income students for four years â&#x20AC;&#x201D; a nearly 67 percent increase in enrollment of first-time, full-time low-income students. Alternatively, these funds could be used to reduce the price for low-income students at these schools by an average of $8,000 per year for four years.

The Center for Behavioral Health Alcohol and Drug Use Among Statistics and Quality released the data Young Adults from the National Survey on Drug Use and Health (NSDUH), aa data collection that offers insight into substance use and treatment, including an overview on drinking and drug use among college students in the United States. The survey found that of the 9 million full-time college students in the US, 9.9 percent aged 18 to 22 drank alcohol for the first time in the past year, and 6 percent used illicit drugs for the first time in the past year. Nearly 60.1 percent drank alcohol in the past month, with 39 percent engaging in binge drinking and 13.2 percent engaging in heavy alcohol use. Twenty-two percent used an illicit drug in the past month. Additionally, the data show that full-time college students who used alcohol in the past month drank an average of 4.1 drinks per day on the days they drank. And full-time college students who consumed alcohol in the past month drank an average of 6.4 days per month.

Mental health practitioners, college administrators, and professors are increasingly concerned over “helicopter parenting,” a style of parenting characterized by over-involvement and intervening in the decision-making of emerging adults. Building on existing research in this area, a recent study examined the impact of “helicopter parenting” on emerging adult mental and physical well-being, as compared to the impact of “autonomy supportive parenting,” where a parent is supportive but not over-involved.

Helicopter Parenting and Wellbeing in Emerging Adults

The study found that college students who had a parent who allowed them more autonomy reported higher life satisfaction, physical health, and self-efficacy — the ability to handle tougher life tasks and decisions. In contrast, students who had a “helicopter” parent were more likely to report low levels of self-efficacy. Additionally, students with low levels of self-efficacy reported higher levels of anxiety and depression, lower life satisfaction, and worse physical health.

A study published in the Journal of American College Health examined food security and fruit and vegetable consumption Nutrition among college students. The study found that for students who lived in housing that did not provide food, males, underrepresented minorities, and those without car access were more likely have lower food security. Furthermore, those with marginal or low food security ate fewer daily servings of fruits and vegetables. Among students living in housing with food provided, the researchers found that Asian students ate significantly more daily servings of fruits and vegetables than white students.

A recent study in the American Journal of College Health found that among college students, daily tobacco use was Sleep associated with more sleep problems than was binge drinking, illegal drug use, obesity and working more than 20 hours per week. The study also found that students with depression or anxiety reported more sleep disturbances than their peers without either disorder. Furthermore, among those with depression or anxiety, tobacco use was associated with the most sleep problems. The researchers indicate that students with depression or anxiety are more likely to use tobacco, which likely exacerbates their sleep issues. In the Spring issue of the Mary Christie Quarterly, Dr. Charles Czeisler discussed new research by the Division of Sleep and Circadian Disorders at Brigham and Womenâ&#x20AC;&#x2122;s Hospital that showed a sharp correlation between sleep deprivation and GPA, as well as between sleep deprivation and reports of anxiety and depression.

A recent study published in the British Journal of Sport Medicine examined the prevalence of depressive symptoms in college athletes. The study found that nearly one quarter of college student athletes display clinically relevant levels of depression, a rate that is comparable to their non-athlete peers.

Depressive Symptoms among Student Athletes

The findings counter assumptions and research showing that those who are physical fit are also mentally healthy. The study found that female athletes were about two times more likely to experience depressive symptoms than male athletes, at nearly 30 percent compared to 18 percent of males. Though the reason for the significant rate of depression among student athletes is unknown, the studyâ&#x20AC;&#x2122;s authors speculate that this may be a result of unique aspects of the lives of student athletes, including higher pressures put on them by coaches, more demands on their time, and underlying body image and self-esteem issues.

A recent study published in the InRacial Disparities in Mental ternational Journal of Health Sciences Health and Substance Abuse examined the racial disparities in the Treatment rate of mental health and substance abuse care received by young people. The study found that black and Hispanic young adults received outpatient mental health services at about half the rate of their non-Hispanic white peers for all types of care. While the study also observed mental health care for children, disparities were generally larger for young adults. Study authors speculate that psychiatric and behavioral problems among minority youth result in school punishment or incarceration, but rarely mental health care.