Fostering Study Abroad Amidst Psychological Challenges

1. Fostering Study Abroad Amidst Psychological Challenges The Forum On Education Abroad Annual Conference, Charlotte, NC March 24, 2010

2. Agenda • Introduction • Psychological Overview of College Students Today • Challenges Faced • Late-Adolescent Brain Development • Case Study Break-Out Groups • Application Process/Pre-Departure • Arrival On-Site • Enrollment: During the Semester • Best Practices Group Reporting • Wrap-Up

3. Psychological Overview of College Students today

4. Challenges Faced • Numerous studies reported increase in college students at American institutions with significant psychiatric concerns. • According to 2008 American College Health Association-National College Health Association (ACHA-NCHA) Executive Summary, college students reported experiencing following health issues severe enough to impact academic performance:

5. Health Issues Impacting Academic Performance • Stress 33.9% • Sleep Difficulties 25.6% • Depression/Anxiety Disorder 16.1 % • Relationship Difficulties 15.9 % • Alcohol Use 7.8% • Attention Deficit Disorder 7.4% • Substance Use 2.4% • Eating Disorders 1.3 %

6. Challenges Faced continued • Additionally, number of psychiatric prescriptions on college campuses has increased dramatically over past decade. • According to 2008 ACHA National College Health Assessment, 14.9% of students reported a diagnosis of depression in their lifetime. • Of these, 32% reported being diagnosed in past school year, 34.5% reported being currently in therapy for depression and 35.6% reported currently taking medication for depression.

7. Challenges Faced continued From ACHA-NCHA: 1.3% of students reported attempting suicide at least once during past year and 9% reported seriously considering suicide at least once. Thousands of these students enroll in study abroad programs. Administrators report 10-15% of study abroad students have some kind of mental health issue, with depression most common. Study abroad professionals are frequently not equipped to manage theses immediate mental health needs, and many of these students go untreated until a crisis.

8. Late-Adolescent Brain Development: Impulsivity and Risk Assessment • Impulsive decision making is hallmark of adolescence. • Often attributed to hormonal fluctuations alone, recent scientific studies show adolescent brain development plays critical role in how and why teens act way they do.

9. Brain Development Continued • Once thought to be completely developed by age 12 (when brain reaches maximum size), neuroscientists now know development continues well into early 20’s. • Teenage brain decision-making process differs significantly enough from fully mature brain to potentially put teens at higher risk of making poor and impulsive decisions.

10. Brain Development Continued • Prefrontal cortex, region of brain responsible for ‘executive functioning’—planning, thinking through consequences of behavior and assessing risks—does not fully mature until mid-to-late 20’s. • Neuroscience research on adolescents show teenage brains favor brain’s amygdala when assessing risk and making decisions.

11. Brain Development Continued • Amygdala, associated with emotional, ‘gut’ responses and quick, instinctual reactions, develops far earlier than prefrontal cortex • Amygdala is thought to take primary role in teenage decision making particularly over prefrontal cortex in emotionally charged situations. • Neuroscientists have found teenage brain decision-making process is more deeply rooted in amygdala and ruled by reactivity rather than rational-thought of the prefrontal cortex. • Immature (teenage) brain by definition reacts impulsively and with higher degree of risk-taking behavior.

13. How does this impact study abroad? • 1998/1999 2.5 % of Study Abroad Students were freshmen. • 2007/08 3.5% of Study Abroad Students were freshmen. • Rise of 1%, although seemingly small, accounts for additional 2,600 young Americans studying abroad. • Total nearly 9,200 freshmen students studying abroad. • Freshman are typically 18-19 years old with brain development favoring emotional, instinctual decision-making rather than mature risk-assessment of fully developed prefrontal cortex. How can we best support our younger student population, and structure our programs to address the needs of this younger population? (Data from IIE Open Doors 2009: Profile of U.S Study Abroad Students 1998/99-2007/08)

14. Case Studies for Break-Out Groups Case 1: Application Process/Pre-Departure Case 2: Arrival On-Site Case 3: Enrollment: During the Semester

15. 1. Application Process/Pre-Departure • Situation: Student discloses on application they are currently undergoing psychological counseling for eating disorder on home campus and would like to continue treatment while abroad in a non-English speaking country. • Event: During scheduled advising session, after preliminary information session student self-discloses seeking treatment for diagnosed eating disorder. Student explains that she is very concerned as she’s heard it is impossible to study abroad and receive counseling at the same time in non-English speaking country. She is considering using provider, but wanted to seek advise first.

16. 1. Application Process/PreDeparture • Risk Focus: Student has healthy approach to risk by wanting to study abroad, but recognizing need for continued treatment in country that should be arranged in advance. • Gap/First-Year Focus: How would best practices differ for younger abroad population?

17. Questions Home School: • What is your best practice to discuss importance of disclosure during campus information sessions and pre-departure meetings? • How is or is not student wellness/mental health/psychological office at home school utilized? • What records does study abroad office have access to when advising a student on program type or location? What records does admissions office have access to? What communications exist between study abroad office and admissions office/student life? • What are legal realities of self-disclosed medical issue and working with student to maintain confidentiality? Provider: • How do you communicate to students that disclosure is in best interest and does not mean they can’t go? • How do providers liaise and communicate with home schools? • Do you have English-speaking counselor on staff or on retainer? • Is site high-risk site and perhaps not best for support on ground?

18. Questions Continued Psychologist: • How do you begin conversation with patient who wants to study and has an illness, which can easily be exacerbated by studying abroad? • Discuss feasibility of study abroad and location selected and offer with appropriate permission to speak with counselor abroad before leaving.

19. 2. Arrival On-Site • Situation: Student does not disclose anxiety disorder on required medical form of home school or provider. • Event: Student arrives in country and after going through immigration and customs is told bag is lost. Once student is informed, has serious panic attack in airport. Program provider meets student and student discloses what happened along with tendency for panic attacks. Throughout semester other situations arise related to entering and leaving country causing additional panic attacks.

20. 2. Arrival On-Site • Risk Focus: Student feels anxiety disorder is under control and does not want anyone to know, nor does s/he think the change in environment will impact the disorder. • Gap/First-Year Focus: How would best practices differ for younger abroad population?

21. Questions Home School: • What is your best practice to discuss importance of disclosure during campus information sessions and pre-departure meetings? • How is or is not student wellness/mental health/psychological office at home school utilized? • What records does study abroad office have access to when advising a student on program type or location? Provider: • How do you communicate to students that disclosure is in best interest and does not mean they cannot go? • How do providers liaise and communicate with home schools? Psychologist: • How do you begin conversation with patient who wants to study and has an illness, which can easily be exacerbated by studying abroad?

22. 3. Enrollment: During the Semester • Situation: Abrupt decision by student, who did not disclose psychological issues, to leave program within first week. • Event: Student arrives in country for program without any indication on application of areas of concern and announces that they are leaving at end of first week. They enter the local onsite office and demand a ride to the airport without disclosing what the issue is that sparked the decision.

23. 3. Enrollment: During the Semester • Risk Focus: Student feels issue is under control and does not want anyone to know, nor does she think the change in environment will impact the disorder. Student was embarrassed and could not face people she felt she had let down as that felt like an even bigger risk than just leaving. • Gap/First-Year Focus: How would best practices differ for younger abroad population?

24. Questions Home School: • Is there, and if there is a policy what is policy regarding attendance, participation and financial implications? • Who needs to be notified and when? And with whom can you discuss the situation? • Can student return to home school without any academic or psychological review? Provider: • What is host institutions policy regarding attendance and participation? • If student withdraws from the program what are financial implications for program and when/if they return to home school?

25. Questions continued Provider (con’t): • Depending on type of intervention what are policies if a student has missed class, can they still academically register with host institution if they choose to stay on study abroad program? • Who needs to be notified & when and who can you legally speak to? • How do providers and/or schools abroad liaise and communicate with home schools & host institutions? Psychologist: • What kind of preventive measures could be taken prior to departure? • What kind of training should on-site staff receive to best prepares to handle this type of situation? • What follow-up should happen upon return to the home school?

26. Best Practices Presentation from Break-Out Groups

27. Wrap-Up

28. Works Cited

29. American College Health Association. American College Health Association-National College Health Assessment: Reference Group Executive Summary Spring 2008. Baltimore: American College Health Association; 2008. • www.acha-ncha.org

30. Works Cited Continued • Time Magazine, What Makes Teens Tick; A flood of hormones, sure. But also a host of structural changes in the brain. Can those explain the behaviors that make adolescence so exciting—and so exasperating? Claudia Wallis and Kristina Dell. May 10, 2004. • Inside the Teenage Brain. Frontline/WGBH Boston, Program #2001, Original airdate: January 31, 2002. • Jay Giedd, neuroscientist/researcher at National Institute of Mental Health. • Deborah Yurgelun-Todd, director of neuropsychology and cognitive neuroimaging at McLean Hospital in Belmont, Mass.

31. Works Cited Continued • Kurt W. Fischer, professor of education and human development and director of the Mind, Brain and Education program at he Harvard Graduate School of Education. • William T. Greenough, professor of psychology and psychiatry and cell and structural biology and director of the Center for Advanced Study and the University of Illinois. • Daniel Siegel, author of The Developing Mind: How Relationship and the Brain Interact to Shape Who We Are (Guillord, 1999) and associate clinical professor at UCLA School of Medicine. • Paul Thompson, assistant professor of neurology at UCLA’s Lab of Neuro-Imaging and Brain Mapping Division. • Heads Up Real News About Drugs and Your Body, Teens and Decision Making: What Brain Science Reveals. Scholastic and the New York Times, April 14, 2008

32. Contact Information • Janet F. Alperstein, The Hebrew University of Jerusalem, jalperstein@hebrewu.com • Nora Dock, St. Edwards University, norad@stedwards.edu • Irene Gawel, GlobaLinks Learning Abroad, igawel@globalinksabroad.org • Dina Nunziato, Sarah Lawrence College, dnunziato@sarahlawrence.edu