Insights from Jackie Cotton, MD, based on the latest episode of REACHing Solutions, a podcast from The REACH Institute.
For many young people, heading to college is one of the first times they will be responsible for navigating so much on their own.
New academic demands. New relationships. New routines. For some, a new city and a new support system.
Even for adolescents who appear to be doing well, the increased demands of college and independent living can expose challenges that were easier to manage at home. Anxiety, depression, and other mental health concerns may become more apparent when young people are suddenly responsible for managing their own schedules, self-care, relationships, and responsibilities.
But how can pediatric clinicians help prepare them?
In a new episode of REACHing Solutions, primary care pediatrician and REACH faculty member Jackie Cotton, MD, shares an approach that starts not with a checklist — but with a conversation.
Ask Questions, Then Listen
Preparing a patient for the transition to college doesn’t always mean telling them everything they need to know.
Dr. Cotton encourages clinicians to create space for adolescents to reflect on what comes next.
“What are you thinking about after high school?” she might ask. “How does that feel for you?”
From there, conversations can naturally open the door to discussions about strengths, challenges, self-care, and mental health.
Open-ended questions can take time — a resource that is always in short supply in primary care. But Dr. Cotton points out that while closed-ended questions may be quicker, they don’t always reveal the information clinicians need.
Sometimes, questions like What challenges do you see ahead? or How do you think you’ll navigate them? can offer valuable insight while also helping adolescents practice thinking through problems independently.
College Readiness Is More Than Managing Appointments
The transition to college is often discussed in practical terms: Does the student know how to manage their medications? Do they know where to access care? Have they arranged accommodations?
Those conversations are important. But preparing for greater independence also means helping young people develop confidence in their ability to communicate, ask for help, and navigate challenges.
As Dr. Cotton explains, communication and self-advocacy are especially important skills for young people preparing to leave home.
That doesn’t mean every adolescent will be ready to take complete control immediately. Independence develops gradually. But giving young people opportunities to lead conversations about their own health and concerns can help them begin building those skills before they need to use them on their own.
For more on the practical side of preparing patients to manage their health needs at college, see our previous article, When Adolescent Patients Transition to College: The Provider’s Role.
Help Students Think About Their Support Systems
One of the biggest changes college can bring is a shift in relationships.
A young person’s familiar friend group may change dramatically after high school — even for students who remain close to home. And activities that once provided a sense of community may no longer be part of their daily lives.
Dr. Cotton encourages students to “find their people”: trusted individuals and communities that can provide connection and notice when something doesn’t seem right.
That support may come from friends, roommates, teammates, clubs, campus organizations, or others. The important thing is helping young people think ahead about how they will build connections in a new environment.
This can also create an opportunity to talk about when to seek help — and to normalize the fact that asking for support is part of navigating a major transition.
Keep the Door Open
Perhaps the most important preparation doesn’t end when a student leaves for college.
For Dr. Cotton, maintaining communication is crucial, particularly for young people with whom a clinician has developed a long-term relationship. But that communication may look different as adolescents become young adults.
And clinicians can begin laying the groundwork long before the final “college visit” by regularly giving adolescents opportunities to speak for themselves.
“Keep the doors of communication open,” Dr. Cotton advises.
That might be the most important takeaway: the goal isn’t for clinicians to anticipate and solve every challenge a young person will encounter after high school.
It’s to help them build the confidence and skills to recognize challenges, communicate about them, and seek support when they need it.
Want to Hear the Full Conversation?
In the full episode of REACHing Solutions, Dr. Cotton dives deeper into:
- Why the transition after high school can be a particularly vulnerable time for mental health
- How to start conversations that help adolescents identify their strengths and concerns
- Supporting young adults as they take greater responsibility for their health care
- Preparing students to manage medications and maintain continuity of care
- Helping students recognize when they — or a friend — may need additional support
- Navigating the changing relationship between young adults, parents, and pediatric clinicians
