Helping Hands Around the Globe

1. Helping Hands Around the Globe Enhancing the Support Network for Students Studying Abroad and Their Program Coordinators June 2, 2011 Maureen Mahoney, Margaret Ross, Debra Terzian

2. Trustees Presentation Who We Are…. • Introductions of presenters • Scope of BU’s International Programs • 1500 BU students studying abroad every year, increasing • 90 international programs, 16 sites totally staffed • 800 students from 145 other universities and colleges • Exchanges and consortia with other programs • Changes in past few years in diversity of programs • Why this presentation? • Discovery: Work in Progress!

3. Trustees Presentation It Sounds Like Fun…What Is the Problem? • College Life these days…. Not so much this….

4. Trustees Presentation

5. Trustees Presentation • More this…..

6. Trustees Presentation More this….

7. Trustees Presentation College Life 2011 • Financial pressures, need for “practical” major • “Should I take the time to go abroad or is it frivolous?” • “Millennial Cohort”: less prepared to be away from home, less hands-on life experience, less resilience • Homesickness • GPA requirement: students have often worked hard at academics, less facile with life skills • TECHNOLOGY: Double edged sword!!

8. Trustees Presentation More Problems in going abroad • Adjustment to a new culture superimposed on the already stressful adjustment to college life may lead to worsening or new onset of • eating disorder • bipolar disorder • depression • anxiety disorder • substance use • dysregulated behavior

9. Trustees Presentation Overview of Presentation • Potential Pitfalls (Expected, Unexpected) • Advance Preparation: • How it Can Help • What to Do • Practical Strategies • How Mental Health Services can Help

10. Trustees Presentation PITFALLS: Business as Usual • Medication: Losing it, having it stolen, not having enough, experimenting with dosages

11. Trustees Presentation Pitfalls (the usual) Parents…. • Parents may be part of the problem OR part of the solution. • In denial about problems child is having? • Or overly anxious and wanting to bring student home precipitously

12. Trustees Presentation Pitfalls: The Usual Getting There

13. Trustees Presentation Pitfalls: Jet Lag, Arrival, Acculturation • Bipolar students • Homesickness • Acculturation: Customs, Money and Language • Difficulty of communication between students, coordinators, homestay, home, school

14. Trustees Presentation Pitfalls: the Usual ALCOHOL • New cultural norms • Availability and Access • Perception of distance and invincibility

15. Trustees Presentation Pitfalls: the UNUSUAL and AWFUL • Death • Serious illness or accident • Terrorism • Local political and military unrest • Legal trouble and arrest • Natural disasters

16. Trustees Presentation THE QUESTION:What’s an Abroad Coordinator to Do?

17. Trustees Presentation Preparing Ahead • Short Break to explain “Work in Progress”! • Example: A. in Geneva, winter 2011 • Example: J. in Geneva, spring 2011

18. Trustees Presentation Preparing AHEAD • Encourage students to disclose pre-existing mental health issues. However, this is VOLUNTARY and many students will not disclose. • New sentence has been added to acceptance letter. We ask at the time of acceptance whether the student has mental or medical health issues • WHO reviews the applications and health forms? • What to do with the information?

19. Trustees Presentation Preparing AHEAD • Ask for/REQUIRE signed permission to speak with health care providers • Ask students to speak with health care providers about wisdom of the abroad plan…early on, if possible • Clearly, this is problematic piece of the puzzle. To be discussed! • Example: G, eating disorder, outside therapist, summer international program?

20. Trustees Presentation ADVANCE STRATEGIES: Medication • Work in advance on medication issues! • Murphy’s Law: • Anything that CAN go wrong, WILL go wrong • Will student be willing to disclose medication situation to coordinator of program?

21. Trustees Presentation Advance Strategies: Medication • Procurement of refills (Mail? Local clinician? Parents?) • Airplane travel: it only gets more interesting (think TSA) • Lost, stolen luggage or pill bottles • Will there be problem with having the medication in the host country?

22. Trustees Presentation Advance Strategies • Proper training for coordinators and proper materials available to them (on line, written): to be continued • Protocols for every contingency, and clear policies for terminating student from program as needed • Behavioral, interpersonal • Mental Health or physical health • Academic • Policies, procedures, contracts all reviewed by legal counsel for university

23. Trustees Presentation Advance Strategies • Basic training of the Study Abroad staff is invaluable and may be accomplished in coordination with Mental Health Service at the educational institution • Common signs of distress • Knowing to whom to turn when problem arises • What to do in case of true mental health emergency such as mania, severe depression with suicidality, panic disorder with thoughts of self harm, worsening eating disorder, psychotic break

24. Trustees Presentation Advance Strategies: • Identify clinicians in the locality where student will be staying—eg. Student with eating disorder may need to be weighed, have simple check-in plan; depressed student may need therapy and possibly medication review • Are there clinicians who can assess a student’s safety if student must travel home? • What about local hospital for mental health emergencies?

25. Trustees Presentation Preparation • In a situation in which the student’s situation is at all tenuous: requirement that student sign an individualized contract in advance: permission to communicate with treaters at home and abroad, adherence with medication, appointments, weight maintenance, and reporting problems to coordinator. • Consequences of contract violation? Spell them out in advance!

26. Trustees Presentation Preparation • KNOW INSURANCE SITUATION… Tricky enough in THIS country; how much more so abroad!

27. Trustees Presentation An OUNCE of PREPARATION…………… Is WORTH a POUND of CURE:Plan ahead for the coordination of International Programs and Mental Health Services

28. Trustees Presentation Identification of Support Network • Working with other students in program who may have access to crucial information • Parents • Working with local clinicians and hospital network • Consultation with home educational institution—easier with email and other newer technologies (Skype) • Having the information ready at hand when an emergency happens • Having met with and trained with home institution mental health clinicians so they are KNOWN

29. Trustees Presentation More Examples from Real Life

30. Trustees Presentation Summary • International programs offices are dealing with students who arrive with more complex problems and who want to go out into all sectors of the global village, ever more fraught with problems of disease, conflict, terrorism…to mention a few • Directors and coordinators “in the field” are confronted with problems that are well out of their zones of comfort and expertise • Coordination between mental health services and offices for international programs is essential

31. Trustees Presentation Summary • Advance preparation for situations, both common and unusual, can make a great difference in the quality of the experience for both students and coordinators • ….and sometimes can make the difference between life and death. • Thanks, Bibliography, Questions and Answers

32. Trustees Presentation Bibliography • A World Awaits You – Students With Non-Apparent Disabilities Go Abroad • By Scheib, Michele. Eugene, OR: Mobility International USA. • http://www.miusa.org/publications/books/nonapparentdisabilities • Assessing Our Resources: Mental Health Considerations for Students in Education Abroad Programs • Duston, Laurie http://www.forumea.org/documents/ForumStandardsInstitute-LaurieDuston.pdf • Managing Students in Crisis: Mental Health, Student Behavior, and Study Abroad Management • Council on International Educational Exchange (CIEE). • http://www.ciee.org/study/advisors/managing-crisis.aspx • Karin Fischer, The Chronicle of Higher Education; June 2 2010: Study-Abroad Programs Should Be Prepared for Mental Health Crises, Speakers Advise

33. Trustees Presentation Bibliography, continued • Mental Health and Study Abroad: Responding to the Concern • McCabe, L. International Educator, 14(6), 52-57. • http://studyabroad.msu.edu/safety/presentations/MentalHealthEducationAbroadNovDec05.pdf • NAFSA’s Guide to Education Abroad for Advisors and Administrators • Brockington, J.L., Hoffa, W.W., and Martin, P.C. (eds.). Washington, DC: NAFSA Association of International Educators. • Over-Stressed, Overwhelmed, and Over Here: Resident Directors and the Challenges of Student Mental Health Abroad • Lucas, J. Frontiers: The Interdisciplinary Journal of Study Abroad, XVIII, Fall 2009 p187-215. • Study Abroad and Mental Health: Identifying, Assisting, and Referring Students in Distress • Settle, W. Safety Abroad First Educational Travel Information (SAFETI) On-Line Newsletter 3(1). http://www.globaled.us/safeti/v3n1_settle.html

34. Trustees Presentation Bibliography, continued • Columbia University Global Health Online Directory • http://globalhealth.columbia.edu/sitemap • Mental Health and Crisis Management: Assisting University of Notre Dame Study Abroad Students. 2nd edition. • www.nd.edu/%7Eucc/International_Eds_Hdbk__II.html • Sample Study Abroad Handbook • www.nafsa.org/about.sec/migs/opo_sig_net/document_library_26/sample_ea/ea_handbook

35. Trustees Presentation Summary: