School

SPEAKER: Welcome to Tips for Transitioning
into College Life.
Helping Teens Make Healthy Choices.
Welcome to the virtual classroom.
This is actually an interactive classroom.
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in the presentation by clicking on the boxes on the left.
There are 10 chapters, in addition to an introduction
and a resource page.
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if additional questions come in after that.
Thank you very much.

ELIZABETH LEE: Hi, I'm Dr. Elizabeth Lee.
I'm a family physician here at PAMF.
I've been here for almost 20 years.
I've been very interested in adolescent health
and have been working in the adolescent interest group
here, developing education for teens and young adults.
NANCY BROWN: And I'm Nancy Brown.
I'm a developmental psychologist,
and have also been PAMF for more than 20 years
and the mother of two amazing young adult daughters.
And I manage the community resource center
where we get a lot of questions from parents
who are struggling with the transition
that their teenagers are going through
as they become young adults and leave for college
or return for the college.

Today we're going to encourage you to start the conversations
about, among other things, how family relationships change
as young adults go to college, whether they're living at home
and going to a community college,
or whether they're going far away.
Everyone comes home sooner or later.
And we're going to encourage you today
to talk about the issues that tend to be pretty sticky.
Things like money, communication, travel, storage,
everything about that transition to college.
Whether it's good, bad, or ugly.
There are issues about friends and responsibilities
of adulthood, nutrition, being responsible
for your own health care, emotions, knowing
how to manage your physical health
as well as manage stress, how parents can deal
with homesickness and school load, and help their kids still
stay healthy while managing these new independent lives.
We'll also talk about alcohol, drugs, and sex,
mostly to encourage you to bring the conversations up
so that your young adults have a chance to really process
with you their understanding of consent
and how to prevent some pretty nasty consequences of not being
used to managing some of these activities.
This can be a pretty tough summer, not only for your kids,
but for you.
I strongly suggest that even if you've never done it,
that you arrange a daily time to check in
and spend more time together, and talk about things
you may never have needed to talk about.
Kids kind of switch from four-year-olds to 30-year-olds
without any notice.
And if you're not ready for it, you just
feel like you've been broadsided when your kid gives you
an angry response to asking them to do
their dishes or their laundry.
When kids want to fight back against rules
that they've never really fought against as teenagers.
They may say I'm going to drink at college, why can't I
do it now?
And then some mornings they may wake up and just
beg you not to make them go to college because they're not
ready.
And they're frightened of all the transitions
that are coming their way.

Some of the things to consider before your teen or young adult
leaves are things like, how are you
going to get to and from school?
Are you driving or are you flying?
Is that you're going alone or are you
going to drive with them and carry out the things?
What is the cost of each trip home?
How often are you going to pay for them to come home?
Is it for only major holidays?
Is on weekends?
Who pays for what?
And what are you going to do with all the stuff
that they're taking to school during the summer?
Not all colleges provide summer storage
so it could be that you're agreeing
to drive to Kansas six times.
You know, every time at the beginning and the end
of every year, eight times, to pick up all their stuff
and move it or pay $700 a month for a storage unit, which
there are always by colleges.
Before you start having a conversation about a car,
you need to understand the campus policy.
Some campuses don't allow freshmen to have cars at all.
They also have rules about whether they live on campus
or not.
But apart from that campus rules, you and your young adult
need to talk about who's going to pay
for car maintenance, and insurance, and tires.
And can other people drive this car?
And what happens if they don't get the oil changed and checked
the water, et cetera?
And campus parking is huge.
It can be really, really expensive.
And when they get tickets they'll
come up on you if you own the car.
So all of these things may have not
been issues when they were in high school,
but they're sure going to be issues in college.
Along with that kind of logistical thinking
is things like budgeting and money.
Kids who live with us, I don't think really
understand how much money they actually
spend every month because mom or dad is always
putting the money out.
So it's a great idea to go to your bank
and open a joint account where parents can see the expenses
and can also drop a certain amount of money
in that is pre-determined.
And having the conversation about how much money
will be spent really is dependent on where your son
or daughter goes to school, whether it's
in downtown Manhattan, where their meal card works at all
of the expensive restaurants.
And they don't realize they're spending
$18 for a avocado sandwich.
They just swipe and go.
And so they're out of money mid-month.
And how are you going to handle that?
If you have the conversation up front
it's a lot lower conflict to work out these issues.
If this all just erupts, it's going to be a lot harder
to process with your youth.

ELIZABETH LEE: So now we're going
to talk about transitioning to adult health care.
And as your teen young adult turns 18
they also might be wondering, why
do I have to switch doctors?
Now if your child has had a family doctor,
they have to change doctors.
They can just continue on with the doctor who's known them.
But if they have a pediatrician, pediatricians typically
care for teens til they're 18.
And then we'll ask them to transition to an adult doctor,
such as an internal medicine doctor or a family doctor.
Sometimes if your child has a chronic illness
or a serious medical condition, the pediatrician
might keep them for a little longer to help them
transition through those early young adult years
and then may actually know of an adult doctor they
want to hand your child off to.
So if you're a PAMF patient, this
is usually what we do here.
Your pediatrician will usually have a few doctors
they would recommend you transition to
and help you "graduate" out of pediatrics.
And so the other thing that comes up
during this time of transition is
how is your child going to get health care
and what do you do about your insurance coverage?
One of the things you should definitely check
is, does your insurance have out-of-state coverage
if your child is going out of state or even
out of area coverage if they're even out of town?
That can be considered out-of-network.
You should make sure that your child
has a copy of your insurance card
and actually knows what it is and how to use it.
You should also check the cost of school provided health
insurance because sometimes this can
be more economical than having your child covered
out-of-network under your own insurance.
There have even been some complicated issues in which you
can maintain your insurance.
But then they have to switch their PCP
when they're at school.
And then they switch back when they're home.
So definitely look into all these nuances
because it can get very complicated.
The other thing that's very important
is transitioning the responsibility of their health
care to your child.
So you may have been the one to make appointments, or order
medications, pick things up for them
from the doctor or the pharmacy, but now
they really have to know how to do that.
So before they leave you should make sure
that they know how to make a doctor's
appointment, a dental appointment, what
their schedule is.
They should know what all their medicines are, their names
of them, what they're for.
You should check into what the local pharmacy in your school
would be.
Sometimes they can use student health pharmacy.
Sometimes it's the Walgreens just outside of campus.
But you should try to find all those resources.
Get them set up for your child.
What I also recommend to my patients
is I'll tell them to have a copy of my business card
and to keep that in their wallet.
And also to write on there, this is my primary care doctor.
Because they can pick up a doctor's card anywhere.
The other thing to do on the back of that card
is to write their medications or medical issues
on the back of those so that if, God forbid,
they were in an accident, had to go to the ER,
the paramedics are going to search for wallets and IDs,
and that will give them a lot of information.
So the other thing that's also very important
is, as your child turns 18 you have
no access to their medical record or any ability
to get information from the doctor anymore.
This is probably the most frustrating thing for parents
because we often get calls to just get immunization records,
or make an appointment, or I just
need to know this one thing for their medication.
And we can't tell you by law.
So we have some information in the hand outs
about how you can get what's called
a continuity of care release so that your child signs it.
So that we can talk to you, the medical providers
can talk to you, about the immunizations
or help you make appointments, that kind of thing.
Your child might not want you to get lab results or things
like that, but you can discuss that with your child.
The other thing that's important to look into
is if you are a Palo Alto Medical Foundation
patient, the My Health Online proxy, that also
and as your child becomes an adult.
Although, there is a way to get access
to extend that proxy between ages 18 to 26.
There is information about this on the PAMF website.
Have to apologize.
It's kind of buried in there, but you can always call them
My Health Online team.
There's a phone number on the website.
And they can help you with that and get the forms signed there.

And then the other thing is just making sure again
that your child has all the appropriate information
about their health care that they need to take with them.
Again, their immunization records, information
about where to get their health care, their medical issues,
and things like that.
NANCY BROWN: You'll also want to remind them
that they're going to need to get a flu shot probably
in the fall when they're at school.
So if they take the initiative and call their health center,
the health center is always happy to come and do
everyone on the dorm floor or something like that.
But you're going to have to remind them to do that,
unless they are local and can come home for a weekend.
Another piece of really important information
is confidential care.
Young adults, actually anyone over 12,
is entitled to confidential care by the state of California.
So most young adults and teenagers
don't know this, no matter how many web pages we build.
Basically, the state law says that if you
want to talk to a doctor about anything related to sex,
sexual abuse, alcohol use, and even mental health issues,
you have the right to do that without your parents knowing.
Every one of our clinicians will honor that.
If a teen calls and says, I'd like
to make a confidential appointment with Dr. Lee
or I want to talk about something
I don't want my mom to know about,
we can mark it on our schedule.
And Dr. Lee knows how to code that so that there
is no explanation of benefits, which the things
that come from your insurance company to the parent that say,
I saw this kid on this date for this thing.
So if they don't want you to see that, then we can stop that.
But there's also a huge web page that the link is on the slide.
And youth can go there and it tells them
how to stop all EAEOBs from their insurance about any
of their medical care.
And that's really important for the 18 to 26-year-old crowd
because they're still likely on their parents' insurance,
but they're adults.
And they're doing things they don't necessarily
want their parents to know.
So all they have to do is send a letter,
and there's a sample letter on that web page,
to their insurance company.
Or call their insurance company and get
them to record the conversation saying,
I do not want EOBs going to my parents.
And that will stop it.
But it's also safe to talk with them about that they
have this right.
And if there is something bothering them
or they want to talk to the doctor about
and don't feel like they can talk to you,
encourage them to use this and talk with their clinician.
Most parents would rather they have the information
than not have the information.
ELIZABETH LEE: And you might be thinking,
why on earth are we telling you how
to teach our children to "hide" medical care from us.
Probably the most important thing to remember
is that if your child doesn't come to the physician who
knows them and has been taking care of them
because they think that this information is going
to get to their parents and they don't feel safe about that,
they will go elsewhere for the care.
And both their regular doctor and you
will be out of the loop.
So this is somewhat of a safety net
to help keep them with a doctor who knows them, and can
advise them, and to try to keep them safe in that respect.
So while it's hard just to let that go and realize
that your child is going to probably do somethings
that you will not know about, if it that keeps them
within the loop and with someone you trust, then
that's the cost benefit there.
NANCY BROWN: Another really important thing
to give you some comfort is that all
of our clinicians and our staff completely understand
that if a child is going through something that they're
terrified to tell their parent about, whether it's shame
based, whether it's just fear, whatever it is,
the first thing most clinicians will do
is encourage the youth to talk with their parents.
Because if you're going to have a procedure,
you're going to be struggling with a medical issue,
having your parents' support is really important.
So our clinicians will always have that conversation.
Our goal is not to hide things from parents.
Our goal is the youth getting the best care they can.
So we will encourage it.
Most clinicians will even offer to have that conversation
with the parent and the teen.
Because the first five minutes is the only really scary part.
Once a parent has an opportunity to kind of freak out and get
a grip, most parents will come around and realize their child
needs their support.

So we've talked a little bit about the changing relationship
with your college bound teen.
And we've talked a little bit about passing
some very clear responsibilities to them
so that they know how to manage their health care
and having the information they need if there's an emergency
or they get ill.
And now, chapter three, we'd like
to spend a little time talking about living with a roommate
and how that's different from living at home.
So most of us in a home, we have figured
out our kids personalities, and their sloppiness,
and their avoidance of responsibility.
Everybody's got good and bad.
And everyone kind of works with that.
We've come to some status quo where life goes on
and everybody works, and goes to school, and eats, and sleeps,
and we've learned how to work that out.
And youths have also developed really long term friendships.
Some kids hitting college have had the same friends
since preschool if they've lived in the same neighborhood.
And those kids don't realize how long those relationships
took to build.
And they don't realize that everyone they've lived with
is not going to be as accommodating
as their siblings or their parents.
So living with a roommate, as easy as it sounds,
is actually far from that.
You can do a great service for your youth if while--
most colleges now let people know who their roommate is,
sometime in the summer.
If you encourage your youth when they're Facebooking,
messaging back and forth, whatever
they're doing, to ask them really basic questions
about their habits.
You're going to be able to help them
alleviate a lot of conflict.
For example, a lot of schools now it's just too much
work to have kids fill out habit questionnaires about sleep,
and quiet, and are you social or not, those kinds of things.
They just throw everyone together and hope for the best.
So encouraging them to talk about what time you go to bed?
What time do you like to wake up?

Are you a clean person or a messy person?
It's hilarious to watch young adults fight
about chaos in these little tiny rooms with two or three kids.
And one messy human can create an amazing amount of chaos
for a very tidy organized young person.
So RAs, residence assistants, are
great at actually helping people resolve these conflicts
and even making chore charts.
It's like walking into a house with a 12-year-old
again, where we used to make the charts of brush your teeth,
and pick up your underwear, and whatever, brush your hair.
Now they can make charts about who cleans
and who does what so that one person isn't picking up.
It's again, communication.
How do you talk about things that you've taken for granted?
You can also talk about expectations about social.
Some dorms end up being open door.
So people are coming and going.
And you're watching other people and listening to other people.
And it's a very social environment.
Most colleges do have quiet times.
So it's after 11:00 and before 6:00 AM, things like that.
But if you're a very quiet, studious child,
you may end up having to encourage
them to live in the alcohol, drug free space.
Or a space that has a theme where
all the quiet kids hang out.
It just takes a lot of communication.
And here I'd like to encourage you to really help
them solve the problems.
It can be really frustrating.
And they may want to call and dump all over you and make you
fix it, but really you can't.
You have to encourage them to use the resources they have
available, whether it's talking to their residence
assistant, or anybody in student life,
or whatever they call it on your child's campus.

Encouraging them to talk to their roommate
and just really keep all those basic messages
your taught your child.
Use I messages, don't column names,
don't be mean, say you're sorry if it's your fault, stay calm,
don't talk about things when you're upset.
We're going to come back to all those things
when you're talking about how you resolve conflicts
with your child, as they're becoming adults.
But all of these lessons apply.
And just encouraging them to solve it,
most colleges will not move them out of a room
just because they can't get along.
So it's important for them to figure out how to compromise.
How to keep talking.
How to set limits that do really matter to you.
And kind of let the rest blow away.

Conflict management is just one step more complex than that.
This applies to anything that is making them uncomfortable.
You want to encourage them not to just assume it's their fault
or apologize for what they're feeling because their feelings
are whatever they are.
They can be angry, they can be sad, they can be frustrated.
It is what it is.
But they have to keep calm and be able to talk through things.
A lot of youth don't really have those skills
because as very concerned, wonderful parents we've
stepped in and kind of placated conflict
and tried to help them avoid it.
But in college they're going to find it.
So teaching them how to talk in a non-combative way
is really important.
And to not respond to an angry roommate
by being defensive because it's just not going to go anywhere.
So teaching them how to say I'm sorry that you're upset.
I can understand how you might see it that way.
Can you help me understand how come
this is so important to you?
I don't feel that way, but I sure
can compromise so that you feel better in our room.
Modeling these things is really the way they're going to learn.
And if you, this summer, do have these conversations
with your youth, they're going to start
developing those communication skills as well.
And they will serve them well when they do get to college.
Here are just some more ideas.
And I think, the second one here,
can you help me find things to do to make
our relationship better?
That is a great line for most parents.
If the summer gets tough or you find yourself
struggling with who's the boss this summer, saying,
I really want to spend time with you.
I'm really conscious that you're going to go away to college
and our relationship is forever changed.
Or, we may not have as much time together going forward.
I would love to spend more time with you this summer,
but I'm not sure what we should do,
how we should spend that time.
I don't want it being just focused
on what you need for your dorm room
and whether or not you have enough pairs of underwear
and socks.
I actually want to spend time we both like doing.
And making time for that is going
to have benefits that you reap for many, many years.

ELIZABETH LEE: OK.
So now we've talked about working
through emotional changes.
And now we're going to talk more about physical changes,
or rather taking care of their physical bodies.
So eating in college.
So, you know, the freshman 15 plus is still a thing.
And what we might not realize is that,
and what your youth might not realize,
is that we still have, for the most part,
controlled their meals.
Controlled their food choices, controlled their portions,
the timing of when they eat.
So when they go off to school--
and some of these colleges have sometimes 24 hour availability
of dining with every kind of food choice available.
They don't really know what to do at first.
At first they eat just to eat whatever they like
and to make sure they feed when they're hungry.
But then they start to gain weight,
or they get constipated, or they start
to feel weird and not good, and they
wonder why that's happening.
So what it's important to talk about with your youth
is just how they're going to approach the dining hall
because it is buffet style.
Again, there's everything that they could want there.
And there's going to be a lot of carbohydrates.
There are going to be a lot of yummy looking things.
And a lot of things that if they were at home they
wouldn't be able to avoid, but they can avoid
when they're on their own.
But just like we teach preschoolers,
you should teach them to eat the rainbow.
Have fruits and vegetables.
Have a balanced diet.
Watch for portion control.
Make sure they get a little bit of every food type.
Do a little health education and remind them
that protein lasts longer than carbohydrates.
Don't eat a lot of sugar.
Things that your doctor would tell you.
Also remind them about things like sauces
and fried food versus baked food.
And trying to have healthier side dishes, occasionally.
Not that they have to deprive themselves,
but just making sure that they're eating
a wide variety of things.
You know, not the fish and chips special
every meal of every day for a week or they
will start to not feel good and get pretty
backed up after a while.

So the other thing--

just in talking about changing of the meals
and not feeling good.

We do include some information about how
to treat common ailments.
Like, if they are constipated, if they have a stomach ache.
Again, these are things that if they came to you and said,
oh, mom I have a stomach ache.
And you say, oh, here have some Tums.
Or, oh, I have a headache.
Here's some Tylenol.
They have to make that decision for themselves.
So it's important to tell them that if you're not
feeling right and the need to listen to their bodies.
And it's good to go out and shop with them
and say, OK, we're going to get you a little first-aid kit.
And he here's what these things are for.
But we do have a little list of how to treat common ailments.
You'll see that in the handouts, that Not So Healthy 101.
NANCY BROWN: So not only do they have
to eat right, and get the medical care they need,
and hopefully, remember to call their mothers,
they also will be put into a space
with 400 or 500 other freshmen, depending
on the size of their school.
But they don't know.
And it may be that they're worried
about this in the summer before they go,
but it may just hit them like a ton of bricks
when they get on campus.
And they don't know who to sit with.
Or they walk into a class and don't know anyone.
And depending on where they go--
one of my kids went to the east coast
and just felt like she physically and emotionally
didn't fit.
Like, who are these people?
She's in sweats and they're in Gucci.
She was kind of like, who is this and where do I start?
And it's really important that if you can talk
about it in advance, to do so.
But also just help them instill some basic rules.
Things like, I won't get my food and go back to my room.
I will try to sit with someone else who is alone.
I will try and learn how to make polite conversation.
We all do it in our business relationships constantly.
You have to talk to people you know nothing about.
And the same rules apply.
Most of us like to talk about ourselves.
Encourage them to have a set of 5 or 10 questions
they can always ask someone.
Where are you from?
And they just have to do it once or twice
and they get very comfortable.
But a lot of the more quiet, shy kids,
or the kids who have had the same friends for years,
feel really like a fish out of water.
And they really struggle to make friends.
And whether it's their freshman year, or in their dorm,
or when they go to study abroad, or when they get a new job,
it doesn't matter, it's a really good skill to have.
And to talk to them in advance.
Another really great way to meet people is to join clubs.
Most colleges have a club fare five or six weeks in, right
after parent's weekend.
So if you didn't talk about it before when you're there
for parent weekend or around that time,
you can encourage them to go to the club fair
and just sign up for lots of clubs,
and get to know where their people are on that campus.
They might be surprised where their people are.
They might join a swing dance class they've never
done before, but actually find that that's
where all the geeks and people like them are hanging out.
Quidditch, most campuses have Quidditch,
which is extremely dangerous by the way,
but it makes rugby look safe.
But a lot of the kids, the Harry Potter generation,
all play Quidditch.
And they can compete against other schools
and it gives them a social life because their tournaments
are on weekends.
So they can always drop the clubs
they don't fit with, but encourage them to just get out
there, get busy, don't sit around their dorm.
I really encourage-- I'm pretty anti- electronics though.
But I encourage parents not to send their gaming system
or television with them into a dorm.
Honest to God, every dorm common room has one.
And it is good for them to have to negotiate and play
with others.
So if you have any power, don't let it happen.
Their phones are more than plenty
enough to distract them and keep them in their own heads.

And if you're not making friends,
try and put a sign up in your common room
or ask your RA who else is spending time
in their room in their evenings, and go make friends with them.
But you really have to encourage your kid to step out
so that they're not lonely.

This is a huge one.
I mentioned it before.
Kids really expect-- like, they've
forgotten how much work it was to build their closest
relationships.
And so a lot of kids come home at the first semester
break, which is Thanksgiving or Christmas,
and they're really stressed by the fact
that they haven't made any good friends.
They've met people, but they don't have any good friends.
And for those people who are really socially connected,
that sense of not having a good friend makes them feel bad.
There's no one to talk to about feelings.
If they don't have a sibling or family they can talk to,
they may start feeling really blue and pretty lonely.
So it's important when they come back,
to remind them that they didn't make
their good friends overnight.
And remind them how much they didn't
like their best friend the first time they met her or him.
And how it took a long time to develop those relationships.
And it kind of sets them on a better path to go back.
The second semester is always better.
Even kids who were really homesick the first semester,
they get a grip.
And if you can get them on the plane, maybe in January,
they tend to go back and realize this isn't so bad.
I'm actually OK here.
But it can be tough.
But just kind of remember to talk with them.
That their expectations may have been a little unrealistic.

ELIZABETH LEE: So if you weren't already feeling
uncomfortable about having to talk
about all these transitional things,
we're going to talk about sex.
So we bring this up mainly to help you open the conversation.
I know many people who will bring their child in and have
me have that conversation with them.
But I think that it's important that in some way,
you get ready to address this because it will be very
much in their faces when they get to school
in some way, shape, or form.

So some of the things that we're going to have you think about--
and you can decide what you feel comfortable with.
But I also encourage you for any of these health things,
get your doctor involved.
This is what they're for.
They want to talk to you and your child about these things
and help mediate things if you don't agree.
But have your doctor get involved
because they are very prepared to have this conversation.
And when I do my pre-college visits with my youth patients,
this is part of the little sex, drugs, and rock and roll
lecture that they get from Dr. Lee.
So one of the first things is, am I ready for sex?
And talking about consent.
It's a very big thing in the news.
And if your child is a PAMF patient
and actually went to school in Palo Alto,
they have a whole health curriculum.
And you may have heard about the sharing tea analogy.
And can you give them tea?
Do they want tea?
Can they reject tea?
If you haven't heard that, you should ask your child
because they may know all about this.
And they actually do a really good job with saying,
if the person is unconscious and they've had tea,
but now they don't want tea, can they still
consent to having tea?
So talk to your kids about this.
But there are definitely good web resources for this too.
The other things you should really
think about and help your child remember
are the consequences of having sex, which is probably
more important than if they feel like they want to have sex.
About knowing about sexually transmitted infections.
Reminding them that most of them are treatable.
Only a few of them are curable.
And they are associated with future infertility.
About pregnancy.
That's one thing.
They don't want unintended pregnancies.
And the consequences of that, both physically
and emotionally.
Talking to them about how they can lower
their risks for both things.
Also, this goes into relationships.
When they're talking with their partner,
if they cannot talk with their partner openly about these
things, preventing pregnancy, STDs, and about sex in general,
and the partner shuts them down, then you should tell them that
they should turn and head for the hills because this is not
a person who is going to value them,
or value their bodies and respect them.
So the other thing that's probably very important too
is, you're thinking oh, this is not our family's way.
They're not going to go off to school and have sex.
And unfortunately, you can't always predict that.
But having a very set understanding
of what your family's values are and what
you've been trying to instill in them for many years
is important to them.
So this is a time to reiterate those things and say, you know,
we in our family, we consider it our value
for you to wait till marriage to have sex.
Or if you don't wait till marriage, then XYZ.
So talk to your kid about those things.

The other thing to remember, they get very social.
There is a lot of peer pressure, but still, the majority
of college freshmen have not had sex.
And to encourage them to remember that it's OK
if they go to college and don't have sex,
and they are actually waiting for the right relationship,
and for them to feel like they're
valued in a relationship before they give
their body to somebody else.
And reminding them again, that this is their body
and they want to be with somebody who respects them.
If you are more comfortable and more
open to talking about things like birth control
and bring them into the doctor to talk about that,
both males and females--
there are a lot of things we can talk about with boys regarding
birth control.
So don't just think that it's for the girls.
And talking about protection from STIs,
using condoms, and being able to make good decisions
in the heat of the moment, and thinking ahead
about what they want to do if they do
get into a sexual relationship.
Also just health and safety wise when they go of to school.
Again, there's going to be a lot of pressure to go to parties.
And there is going to be drugs and drinking at these parties.
I will often advise patients to be very careful about knowing
what they're drinking.
To keep control of their own drinks.
And not drink things that they've been offered
and don't know what's in it.
Also, to have a buddy system.
Have a designated non-drinker, non-user,
so that they can keep an eye out for other people.
And also, just related to the consent issues,
I would say, helping them decide not
to mix things like drinking, and drugs, and sex.
And to really help them make those decisions very solidly
before they go into a situation where they will be pressured
into making that decision.

So just continuing on with that, the alcohol and drugs.
Again, the peer pressure.
Unfortunately, with alcohol we do hear every year
about a child who has died from the binge drinking.
Often they don't realize how much or how little alcohol
it takes to get drunk, especially if they haven't been
trying when they were in high school,
or how much it takes to pass out,
or how much it could take to actually kill you.
So it's important to help them understand this.
This doesn't mean that they have to start
trying under your watch before they leave.
But it's important to make them aware.

The other thing with just the legalization
of marijuana, that they might be willing to try those things.
There's a whole number of medical things
that doctors can talk about, but what it comes down
to is use of marijuana and other drugs
does affect decision making.
It can affect their cognition.
And it can put them in unsafe situations.
In addition to just affecting their health.
So that needs to be discussed with them.
Also just with-- even though with marijuana
there are legalized dispensaries.
With other drugs, they don't know
what they're getting when they're
getting it from someone.
It could be mixed with other dangerous substances,
toxic substances, or other drugs that
could cause a great deal of harm to them
and put them in the hospital.
So just to, not necessarily scare them,
but make them aware that things are sometimes
a little bit like TV.
And that they're a little bit scarier and a little bit more
dangerous than they think they are.
NANCY BROWN: Another really important thing
to encourage them to be conscious of is that most
companies drug test before they get internships
and jobs as part of their routine physicals.
And marijuana is going to stay in your system for quite
a while.
You also want to be really careful with alcohol,
that you understand the interactions
between any medication you're on and alcohol.
So it may be that it hasn't been an issue.
But antidepressants and anxiety meds, things really
you have to understand not only the chemical interaction,
but also how it works in you.
And if you have never drank a lot,
this can be a really rude awakening.
So just think about it and talk about it.
Again, communication is the key.
ELIZABETH LEE: And again, get your doctor involved
if you don't think your child is listening
to you because they can lay out more of the facts for them.
And they might be more willing to listen to that.
But at least that you know that you've
given them the information.

So now we're going to talk about how to manage stress
without drugs and alcohol, or other unhealthy stress
relievers.
So good thing to help your youth get used to
is how to handle their own stress.
Because a lot of times when they were
in school they may have come to you or not, and dumped on you,
and wanted mom or dad to relieve the stress, make it go away.
And hopefully they've learned some in school
or you've been able to teach or model for them some
of these healthy ways to handle stress.
There's no magic to it though.
Important things are, being able to pace themselves,
make time to exercise.
Recommendation is up to 60 minutes a day of moderate
to vigorous exercise.
Getting plenty of sleep, huge, huge, huge.
They are not going to be able to think, they're not
going to be able to feel good, they're not
going to be able to remember what they need for that test
if they don't sleep enough.
And this is something that you can really
press with them while they're still in high school.
But they also have to eat well.
They have to eat regular meals.
They have to be self aware of when they're tired,
or when they're hungry, and think about when they last ate,
and what they last ate.
To be able to talk to others.
Hopefully, they form new friendships
or be able to talk to their resident advisor.
Or if they really need some greater help,
to know what resources they have at school,
to seek some counseling, they may just
need to talk through some things with someone more professional.
And that's OK.
Another thing that is getting to be really
big in a lot of college campuses,
but also just in companies and in the clinics
is our mindfulness programs.
So this teaches them the skills on how
to do meditative breathing and stress relief.
We have classes here in Palo Alto.
There's a place in Menlo Park at the rec center that does it.
Some place in Redwood City.
You can see the resources.
There are also some great apps that
do the mindfulness breathing and meditation.
They have music.
They have stories to listen to.
There's the calm app, which I really like.
There is a free version and there's
an app purchases for the different levels of exercises.
There's Headspace, which is also very popular.
Your child might already know about this.
They sometimes talk about these schools,
but you can see the list there.
But I do encourage them to use their technology
for some of these programs to help them relax.
And I guess the other thing about exercising,
sometimes I'll encourage students to go take a PE class.
It's an easy credit.
And it gets them exercising.
And they can go take a class in something
that they've never done before.
Like, take tennis, or do ballet, or something else
that they might not have done before,
but they're kind of interested in,
in a fairly non-judgmental way.
NANCY BROWN: There are also apps,
like free yoga apps, where you can
pick do you want a five minute yoga experience or a 30 minute?
And they can just do it in their rooms.
So it doesn't have to be organized,
but they just need to be conscious
that they may need a little stress reduction.
They're in a really different world.

So we started this topic with how
your relationship with your teenager or your young adult
is going to change, whether or not
they're going off to a community college
and they're going to live at home,
or whether they're going far away to a college,
or just an hour away.
It doesn't really matter about the transition to college.
What matters is that your relationship with that human
being has to change.
Yes, you are always the mother or the father,
or the aunt, or the grandmother.
And you may control the purse strings.
And you may control the car and the place to live.
And all of those things may still be that way.
Sadly, till they're about 30.
But what you don't get to do is tell them how to behave
and how to feel.
And I think without some kind of a structured ritual,
or a little guidebook, or just some simple reminders,
it is really hard to understand that life is not
status quo anymore.
You have an adult. Somehow you have to give them permission
or just acknowledge that your advice no longer
has to be taken.
Your advice is exactly that, advice.
Just like if a friend gave it.
They take it.
They leave it.
They disagree with it.
But they're adults.
And if you want to have a really positive relationship,
you have to be talking to these little adults, young adults,
just like you would a friend, or a sibling,
or your own parents, who's your relationship with them has also
changed in a huge way.
But just acknowledging that helps you take a deep breath.
Not respond in the same way you always
have reacted to some of your child's behaviors
or tendencies.
Many young people come home during college.
And the first time they do you may be very surprised
that literally they are stinky, and tired, and exhausted,
and they've been eating awful.
And they may sleep 12 to 14 hours a day
and not do their own laundry, and live
for you to cook for them, and take care of them.
But be careful.
Because yes, that feels great after having
your own little empty nest or missing them.
But that's not what adults get to do.
We don't get to have those kind of weekends.
We don't get to just decide someone else
is going to take care of us.
So I think, again, talking through and saying,
oh, I've missed you.
I am looking forward to taking care of you.
I've planned all your favorite meals,
but you're going to do the dishes.
Or, we can do this for the first two days,
but then I need you to start picking up the pieces
because I'm still working full time.
Or we might have other kids in the house.
There are many other things.
And you may not be very conscious
that when your young adult was gone you got into a rhythm.
Chances are good if it was your last child,
your house stays very clean.
And all of a sudden all the jackets,
and the backpacks, and the shoes everywhere makes you nuts.
But you can't scream about it.
You have to actually say, this is really different for me.
This chaos makes me feel stressed.
Can we just come up with a compromise
so that your stuff gets piled in your room
or in this part of the living area so that I don't come home
stressed?
And that's very different.
We don't really have the right to say,
you're going to do it my way or the highway anymore.
They're adults.
And that's not going to build the relationship that you're
going to want with your young adult as they change,
and partner, and move away, and, or give your grandchildren,
and et cetera.
So this is your greatest opportunity
in the world to just start communicating
with them in a slightly different way, using more words
and clarifying your assumptions.
Not letting resentment build up.

Making sure that this new relationship is verbalized.
That you understand they don't have to take your advice.
We're never going to be their friends, nor do we want to be,
but it is a more equal relationship.
And there's always the need for compromise.
One really concrete way to do that with them this summer
is to set up a communication plan.
Because what you may not realize is that you see your child
every day or every other day, however often you see them,
and what you may be assuming will happen because you've
heard about it or you just haven't really
thought about it, is that your child's
going to reach out to you every day or every Saturday
and tell you about how college is.
And you might be a little distraught
when you text or you leave messages for six or seven
days and your child doesn't return the call.
I can't tell you as a freshman advisor how many calls
I got from hysterical parents.
I haven't talked to my child.
I think their dead.
Have you seen them?
And usually, it ranged from 24 hours
to two weeks, three weeks.
Some were more reasonable fears than others.
But if you don't ever say to your child,
I would like to talk with you every Sunday at 6:00,
or I think every three days is about my limit
to not freak out because I'm worried about you,
or whatever it is you're feeling,
you just have to say it and come to an agreement.
So then they're not really angry at you
when you call their freshman advisor because they violated
what they agreed to, which is, I'll call you every three days
or every Saturday, et cetera.
And then for you, don't text every day.
If they're not texting you back or they're not returning
your calls, they're busy.
Hopefully, they're having friends,
not enjoying hours and hours of porn.
But you'll never know unless you ask them.
And it's good to have those conversations, whether you
do it humorously or seriously, but do it
for your feelings are hurt and you hurt their feelings back.
So again, bring stuff up.
State how you feel.
Talk about the new roles and expectations.
Do your best to just acknowledge that your relationship
with your youth is changing.
And to support lots of those changes,
we have pages and pages of resources for you
to maybe share with them if you can
get them to sit still for any part of this presentation.
Or you can just bookmark it on a family computer
and talk about all the cool resources
you saw as you watched and listened to this presentation.
But there's lots of things.
One of the most popular handouts we have is Laundry 101.
And it's linked in your resources.
Again, I think Micah told you, you select it
and then you click on Browse To.
And I've actually laminated these things
in huge quantities.
And kids post them in their laundry room in their dorms.
And they are very popular.
And the really reduce the number of pink clothing
that people wear.
We also have a lot of resources on stress.
And these are the local community health
resource centers.
You may not know that PAMF, as part of its community
benefit commitment to our communities,
has these seven different community health research
centers.
You can go in.
You don't even have to be our patient.
And you can talk to a nurse or health educator about anything
in the world.
And this is where a lot of parents
come in, mostly needing a hug, but asking how other parents
are managing these transitions.
So that's acceptable.
Talking to your doctor is acceptable.
Anybody that you feel comfortable with.
This is not easy for parents or teens.
And I think the bottom line of today
is that we want you to do this as well as possible,
and to come out of it with the best relationship
that you can with your youth.

And before we go, I want to ask Dr. Lee if she
has anything she wants to add.

ELIZABETH LEE: So we just want you
to remember that PAMF is here to partner with you
through this journey.
Please come talk to us, as Dr. brown
said, in the community health resource
centers, or the doctor.
We really want to help guide you through this.
And if you do have other questions,
please remember to take our survey.
You can see the survey link over here
where it says, please respond.
You can put your questions in there.
Please remember, if you do have a question, put your email in.
We will respond anonymously to you via email.
And we will not use your email for anything else.
NANCY BROWN: And even if we don't have questions,
fill out the survey so that we know
how to improve these types of programs and this program
in particular.
But these lectures that are available online
are kind of a new thing for us.
And we really want to know if they're valued,
and how you used it, and how we could improve them.
ELIZABETH LEE: Thanks for coming.