This article is intended for treatment professionals and not a general audience.
I routinely collaborate with many treatment professionals like psychiatrists, psychologists, and therapists in my work. I’m the former director of an outpatient psychiatric center, so I understand how educational and clinical services can work together. One of the frequent questions that I’m asked is “what could become a problem in college that can be detected during the treatment process?” While this sounds like a perfectly sensible question, the difficulty in answering is that it seeks to predict events in the future, which may or may not happen. I’ve personally seen connections, however, between certain “risk factors” and college issues, and there is some research that has identified factors for later college problems. Addressing these risk factors during the pre-college phases is always the best way to prevent problems later in college.
Some of the pre-college issues I’ve seen that can lead to problems in college are:
Lack of effective treatment
A lack of diagnostic clarity or not establishing “effective treatment” could amount to a huge problem for college attendance. The rigors of college academics require that a student be their best mentally, emotionally, and intellectually. Having the additional burden of a undiagnosed or non-responsive condition on top of college coursework can lead to failing grades and more. Effective treatment barriers can include individual factors, like a student not keeping their appointments or not participating in treatment. There can also be family factors, like parent expectations of the student that are too high or even too low. A poor response to pharmacotherapy can be another issue, and I’ve had a number of students whose condition was not adequately treated due to a poor or negative response to a medication trial.
No continuation of care
A frequent issue that I see is when a student who has been receiving treatment during high school goes to college and there is no plan to continue their treatment. The feel that they don’t need to continue regular psychotherapy and will simply obtain medication either through the student health center or their physician when they return home for a visit. What students find out, since every college is different, is that they may not be able to receive psychotropic medication on campus, or if there is a psychiatrist available at the college they only see a limited number of high need students. There are also certain types of medication that their home physician can’t prescribe refills for by a phone call to their local pharmacy, so students can quickly run out of medication and find that their grades suffer. Most small colleges offer no psychiatric care , and some don’t even have therapists on staff. Many of the students I’ve worked with also reported negative experiences when trying to receive psychotherapy at student counseling centers, and this can discourage them from continuing psychotherapy at all. Because it can impact their academic work, not continuing treatment can pose a significant risk for college problems.
For high school students who have been hospitalized for emotional reasons, student stress can be a concern in college due to the increased pressures. More challenging academics can bring a great deal of stress to students, but other factors play a role, such as social issues and the requirement of increased autonomy in their work. Some studies have shown that college students experience anxiety and depression at two to three times the rate of their non-college peers. Having a plan in place to establish and continue effective treatment, plus choosing a college that will minimize the stress, will be key to their success. Not all colleges are equal with how much they can support these students and how much stress the students will experience.
Interaction of individual and college factors
One of the key considerations for at-risk students is the interaction between their personal characteristics and those of a prospective college. Too often the guidance they receive about college while in high school focuses on just getting in to a college, and not whether they will succeed there or not. The characteristics of a college can either enhance and support a student’s traits or work against them. For example, some students find large public colleges to be very alienating places, which can be counterintuitive for schools with such a large student body. They find themselves “alone in a crowd,” and shy students who attend such colleges may find that they never leave their dorm room. For shy students, and especially for those diagnosed with social phobia, smaller colleges that can foster more direct, non-threatening interactions may be better placements. The same characteristics-matching concept is true for issues with attentional capacities, slower learning processes, and other impairments that may stand in their way. For students with some type of disability, proper college planning is truly the key to their future success.
College planning efforts
Probably the most frequent problem I see, which is corroborated by a three-part study sponsored by the Gates foundation, is that students who have little or no college planning efforts are at greater risk for college failure. This study didn’t even specifically consider students with a disability, who can be at greater risk without proper planning. Students often make college decisions based on non-academic and “non-success” factors, such as the school’s social activities, sports teams, or other things that aren’t necessarily related to completing a degree. Identifying colleges that not only have majors and campus activities that students want, but also those who are able to support them academically and therapeutically is critical. I’ve seen many cases where a student had an IEP or 504 plan in high school, yet a college refused to give them academic accommodations to ensure they performed at their best. The college system is very different from high school, and some colleges have very strict requirements for who can and cannot receive accommodations. Too many students accept an offer from a college only to find out once they’re on campus that the college denied them accommodations that they just assumed they would receive.
Many high school students who seek treatment from professionals plan on attending college. For these students, there are special considerations that must be observed to ensure that they have a positive college experience. Establishing treatment that has a positive outcome and then transitioning that treatment to services at or near a college must be done to help them as they progress in to higher education. Careful college planning that observes their special needs, including the ability to receive academic accommodations in college and first-year support, can often make the difference between a successful college experience and problems during their stay.