“Any transition is a time that our patients can trip and fall,” explains Tina Nicholson, MD, a family doctor specializing in children and youth mental health. The transition to college, especially if it involves moving away from home, is no exception.
To understand how providers can help adolescents navigate this transition, we spoke with REACH faculty members Dr. Nicholson and Jasmine Reese, MD, MPH. Both agree that when it comes to preparing patients for college, empowering young people to advocate for their own health needs is essential.
Start Early by Teaching Patients to Advocate for Themselves
“Adolescent patients get used to their parent, grandparent, or other caretaker knowing their health details and having answers,” explains Dr. Reese. “At an appointment, you’ll ask a teenager, ‘Did you eat breakfast this morning,’ and they’ll look over to their parent for confirmation.”
That’s why Dr. Reese recommends starting as early as age 14 to prepare patients to understand and advocate for their own care.
By their teens, patients should know their diagnoses, medications, and medication dosages and schedules. In her practice, Dr. Reese has created a standard procedure where caregivers and teens are separated for the first part of follow-up visits. This encourages teens to practice autonomy in answering and asking questions about their health.
For young adults with ADHD and who are neurodiverse, addressing executive skills is also key. Dr. Nicholson asks patients to walk through how they will handle basics, like creating a morning routine, getting to class on time, and getting enough sleep. She also provides resources, such as referrals to “adulting courses.”
Plan for Continuing Care Needs
Many young adults with mental health disorders prefer to continue being treated by their primary care provider back home. In this case, providers should ensure patients schedule visits before leaving for campus and during school breaks. For patients who attend college in-state, telehealth visits can be useful for interim follow-up visits.
For medication refills, providers have multiple options: write a prescription for a 90-day medication supply; write a prescription with multiple refills; or offer telehealth visits for prescription renewal check-ups. If a medication can’t be prescribed across state lines, in the U.S. a chain pharmacy may be able to do a pharmacy-to-pharmacy transfer to enable patients to pick up refills out of state.
For adolescents receiving therapy, their provider may offer virtual sessions across state lines or they can find an authorized therapist that does so through PSYPACT (the Psychology Interjurisdictional Compact).
Prepare Teens to Access Care Away from Home
Before heading off for college, young people should know where to go for urgent care, emergency care, primary care, and sexual health care. Providers can ask teens to share their plans to access care in advance—and help fill in missing pieces in their planning. If on-campus services are slim, providers can encourage patients to find a primary care provider off-campus and pre-schedule a visit to establish care.
In the U.S., young adults also face the challenge of navigating insurance. Whether they remain on their parents’ plan or transition to college-based coverage, teens should become familiar with what their health insurance plan will cover and what it will not. Dr. Reese assigns patients homework to find and get familiar with their health plan rules, including the difference between in-network and out-of-network care for doctor visits, pharmacies, and lab testing.
Apply for Accommodations Early
Clinicians should encourage patients to submit requests for accommodations to their college well in advance, as some colleges may require letters from specialists which can take time to gather.
However, young people who are neurodiverse or living with other mental health conditions may not clearly recognize their own learning needs. Dr. Nicholson encourages these patients to reflect on their successes and challenges in meeting deadlines, procrastinating, managing workload, and coping with long lectures with few visual cues. This process can reveal additional tools to support students’ learning, such as requesting lecture notes or slide decks before a lecture so they can more easily follow and engage with the material.
Cover the Basics of Vaccinations, Social, and Sexual Health
Dr. Reese talks frankly with patients about how, at college, they may “develop new relationships, meet new people, explore their sexuality and gender identity, have reproductive health needs, and need to think about safe sex.” She reinforces the importance of STI screenings, educates them on where to find sexual health resources, and reminds them that emergency contraception like Plan B is available at U.S. pharmacies without a prescription.
Clinicians should also review vaccination records with teens and ensure they’re up to date with vaccines for meningitis, HPV, and flu.
Be Aware of How the Pandemic Affected Adolescents
While the COVID-19 pandemic may be over, many young people’s social-emotional development is still being affected. Research shows that children and adolescents experienced increased mental health crises and disorders during and after the pandemic. Dr. Nicholson reports that many of her patients who were adolescents during the pandemic, especially those with conditions like anxiety, ADHD, social phobias, and autism spectrum disorder, are now struggling to launch their adult lives, including at college. These young people may prefer to remain behind a computer screen rather than interact face-to-face or on the phone and may require additional support in learning and practicing social and executive skills.
RESOURCES
- Research on how the pandemic has affected children’s and adolescents’ development and mental health is continuing to emerge. Recent research considers the ongoing effects on children’s and adolescents’ mental health and brain development and maturation.
- For concerned parents, the Child Mind Institute offers a primer on how parents can help teens prepare for the social and emotional challenges of college.
- A helpful resource to share with patients comes from Mental Health America, which has created a detailed, student-focused guide for planning to navigate the transition to independence.
- To help families plan for accommodations, both the NTAC Collaborative and Jed Foundation offer useful planning toolkits and resources.
