CAPS

V.A MISSION STATEMENT *

Effective Date: 
Mon, 08/01/2011
Reviewed: 
Thu, 02/01/2018
Revised: 
Sun, 08/28/2011
Policy: 

Outreach and consultation services are provided within the context of a community psychology model.  CAPS provides services to a variety of campus community programs, units, departments, and individuals using primary intervention (e.g., education, mentoring, social support) and secondary intervention (e.g., consultation, debriefing, mediation) approaches. Our psychiatric staff provides psychiatric in-service programs regarding relevant mental health topics, as well as consultations to the greater campus community regarding psychiatric services and medication. Our goal is to intervene in the environment and ecology of the campus in order to enhance the university’s academic mission and promote a harmonious multicultural community in which students can achieve their educational and personal goals.

III.G PEER REVIEW FOR COUNSELING *

Effective Date: 
Sat, 01/01/2005
Reviewed: 
Mon, 05/07/2018
Revised: 
Wed, 01/31/2018
Policy: 

Peer Review is an integral component of the Clinical Quality Management and Improvement program, and shall be conducted on a regular and ongoing basis by CAPS staff.

Purpose of Peer Review:

  • Monitoring of indicators of clinical quality and conformity with UCSC CAPS Service and community standards of care.
  • Identifying opportunities for improvement in clinical care and providing feedback and educational opportunity for staff for clinical service provision
  • Providing information to the Director as one component of the staff evaluation process.
Procedure: 

1.      Twice yearly, during the academic term, five cases per clinician (psychologist, therapist, case manager, intern, postdoc) will be randomly distributed to the counseling staff for peer review.  Three of the cases will include documentation from intake appointments (2 routine and 1 priority intake) and follow up counseling visits, and two will include crisis services evaluations.  The counseling records will include those records starting from the initial contact with the student in the past two quarters under review.

2.      The reviewers will use a peer review form (see below) to evaluate whether the counseling service met CAPS Counseling Services and community standards of care.

3.      Counseling records will be reviewed in the electronic health record.

4.       Clinical documentation recommended by peer reviewers for further review will be reviewed a second time by a member of the CAPS management team.  If a second review is required for the records of a CAPS management staff member, another management team staff member will review the records.

4.      Counseling staff will receive a summary sheet detailing results of the peer review.  This summary will also be provided to the CAPS Director and supervisor of the staff member.  If the counseling staff member disagrees with the peer review results, they may respond directly or in writing to the CAPS Director, who will provide a written reply.

5.      If necessary, training will be provided to the counseling staff on general themes and issues that arise from the peer review process.

6.      Results are shared with the CAPS Clinical Quality Committee and the SHS Quality Management Committee.

Peer Review Fall 2017 – Counseling Senior Staff

Staff Reviewer            _________ _____________                  Student ID number: ___________

Staff Reviewed            ______________________

The history is adequate based on the chief complaint and other entries in the chart.

III.F GROUP THERAPY *

Effective Date: 
Fri, 08/01/2008
Reviewed: 
Mon, 05/07/2018
Revised: 
Wed, 01/31/2018
Policy: 

Definitions:

Group Therapy- A form of psychotherapy which involves a small group of people and 1 or 2 professionally trained therapists who meet weekly to address  common psychological difficulties  or stressors. Group therapy utilizes the group interaction as the primary intervention. Most groups  meet  weekly  and are open-ended.

Psychoeducational group-Meetings involving a small group of students  and 1 or 2 professionally trained therapists organized around a particular theme or topic.  Groups typically meet on a weekly basis and are closed ended.

Documentation:

Each member of a psychotherapy group should have an individual note in our electronic medical record documenting each group session.  Notes should not include the names or other Protected Health Information (PHI) of any other group members.  Staff are not required to keep a group note but can choose to if they wish, as long as it contains no PHI.

Clinical documentation of psychoeducational groups or drop-in support groups is not necessary.

III.E COUPLES COUNSELING *

Effective Date: 
Fri, 08/01/2008
Reviewed: 
Mon, 05/07/2018
Revised: 
Sun, 08/28/2011
Policy: 

CAPS provides couples counseling to both student-student couples and student-non-student couples.

Couples Counseling Documentation:

Each member of a student-student couple seen in counseling at CAPS should have an open electronic health record (EHR) while receiving services.  Each student should have an individual note in EHR documenting each couples session.  Notes should not include the name or other Protected Health Information (PHI) of the partner.  Each member will be asked to sign the Informed Consent form at the outset of treatment that explains the documentation policy regarding couples counseling and also stipulates that, despite our efforts, the partner may be identifiable in the individual record (i.e.-when working with a married couple).

As our mandate and scope of service is to provide counseling to actively enrolled students of UCSC, when a student presents for couples counseling with a non-student an EHR will be established for the student and the non-student will be seen as a collateral to that service.  For instance, a student experiencing depressive symptoms secondary to relational problems will be seen with his/her significant other to address relational issues in an effort to reduce symptomology.  Notes should not include the name or other Protected Health Information (PHI) of the partner but should only refer to a non-student partner who is being seen as collateral to the student’s care.

Couples Counseling and Releases of Information:

Each student in a student-student couple will have the right to request a release of information for their individual record, which will include documentation of the couple’s work.  A student has no right or access to their partner’s health record.  In a student-non-student (collateral) situation, only the student has rights regarding the health record

Key Points: 

Definitions:

Couples Counseling– The process of working with two people who are engaged in a romantic relationship geared towards addressing identified relational concerns.  Focus is typically on identifying dysfunctional patterns and improving communication.

Collateral– An individual  who has close ties to the identified client and is seen along with the client to help achieve treatment goals.

Student- A currently enrolled undergraduate or graduate at UCSC who is paying registration fees.

Non-Student– An individual not currently affiliated with UCSC but in a relationship with a UCSC student.

III.D INDIVIDUAL COUNSELING *

Effective Date: 
Fri, 08/01/2008
Reviewed: 
Mon, 05/07/2018
Revised: 
Wed, 01/31/2018
Policy: 

 

  1. Utilizing a brief-therapy model, CAPS offers time-limited individual counseling to UCSC students.  If specialized or longer-term counseling is indicated, the client will generally be referred to the appropriate off-campus resource.
  2. If a client needs to be seen beyond the agreed upon time limit, the CAPS staff member should discuss the request for extension to a member of the management team.
  3. Longer term individual counseling can be provided by interns, post-doctoral fellows, or their supervisors.  They can carry one long-term case per year.  The decision of which client will be eligible for longer term counseling for the intern is mutually decided by the intern and the primary supervisor.  In addition, all other clinical counseling staff can elect to follow one case throughout the academic year.
     

 

 

 

III.C FIRST FOLLOW-UP APPOINTMENT *

Effective Date: 
Mon, 09/25/2017
Reviewed: 
Mon, 03/26/2018
Revised: 
Mon, 03/26/2018
Policy: 

1. All students seeking services at CAPS are first given an Initial Assessment appointment or a Crisis appointment. At these appointments, the CAPS staff member makes a disposition, which may involve an intake at CAPS.

On campus First Follow-ups.  These are for students who likely need CAPS services and could likely benefit from a course of brief psychotherapy or  transitional therapy to connect with off campus services.  Students who have not completed a Student Questionnaire (SQ) during the current academic year are asked to complete the SQ prior to the First Follow-Up.

2. Consistent with APA Ethical Standards, California law, and standards of practice, CAPS staff must inform the client about the limits of confidentiality and the limits to CAPS services in the initial office visit.   Clients are required to provide informed consent to counseling services, which involves reading, understanding and signing the CAPS Informed Consent Statement.   Trainees must also inform the student of their intern status, who their supervisor is, and obtain release for audio taping of counseling sessions if this was not done during the Initial Assessment.

3. In the First Follow-up session, the CAPS staff member assesses for presenting problem, gathers relevant history, and conducts an assessment of important risk factors.  The CAPS staff member must consider other pertinent clinical issues in formulating an initial treatment plan for the student.  The treatment plan could include individual therapy, group therapy, couples or family counseling, on campus resources, referral for psychiatric/medication evaluation, or a referral to appropriate off campus services.  At the end of the First Follow-up session, the CAPS staff member should inform the client of the tentative treatment plan and rationale for specific recommendations, consistent with APA Ethical Standards and standards of care in counseling or clinical psychology.

4. Staff should use the First Follow-up template to document this service. The combination of the IA and FF represents the traditional Intake process.

III.B INITIAL ASSESSMENT *

Effective Date: 
Mon, 09/25/2017
Reviewed: 
Tue, 05/08/2018
Revised: 
Tue, 05/08/2018
Policy: 

Point of Entry:

Call-ins to the CAPS front desk are the primary and preferred point of entry. The front desk personnel will inform callers of our Initial Assessment (IA) procedure (See Appendix H-Questions to ask when scheduling an Initial Assessment). It is crucial that only true crises go to our crisis service.  An upset student can generally wait for the next Initial Assessment. If students volunteer on the telephone that they are in immediate danger and need to see someone right away they can be told to come in to same day crisis services.  If not, they are to be given the next available Initial Assessment appointment.

An exception to this procedure involves 3rd party contacts: people who walk in or call in because they are concerned about a student.  This could be a friend, RA, professor, family member, etc.  These situations should be routed to the crisis service if possible.  If not available, please route to a member of the management team.  A 3rd party contact note should be completed in the Third Party Security Division of our Electronic Health Record.  If a situation such as this gets to Initial Assessment, the triage person completes a Third Party note, rather than an IA note. (See Section II. G Clinical Services – Third Party Contact Policy)

Some students will still walk in for services. In this case they need to complete the triage form (Appendix A) to help determine their appropriate level of service.   If the student answers yes to one of the crisis questions on the crisis triage form, they are to be seen by the crisis service.  If it is negative, they are to be given the next available IA appointment.

Direct referrals from SHS:  Unless SHS is referring a student specifically for our crisis service, referrals from SHS will be given the next available IA appointment.

Initial Assessment:

The role of Initial Assessment is to direct students seeking services to the level of service they require.  Staff are expected to complete the IA form/template (Appendix I) on the student’s Electronic Health Record (EHR) while they are evaluating the student.  IA appointments are scheduled for 60 minutes, which includes time for a 40 minute in-person consultation/evaluation and note recording.  IA appointments are typically at the CAPS Central Office unless other arrangments have been made. Students come in to CAPS Central at an appointed time.  There is a charge for broken IA appointments ($25), although the first missed appointment charge is waived.  Staff can review past contacts with the student in the student’s EHR for background and context. Students are asked to complete an Informed Consent form prior to the IA and, if they consent, the interview continues.  Limits of confidentiality are also discussed. Students also are asked to complete a CCAPS prior to the IA appointment.

The first step is to determine the presenting problem.  Staff are to explore these issues to the extent necessary to make a disposition decision.  This is not a complete intake evaluation. If staff are taking more than 40 minutes to complete the IA, they are delving into too much detail.  Students should be informed that this is a brief consultation and they will have more time in the future to discuss the details of their circumstances.

Based on the brief assessment the IA person must determine the best next step (Disposition) from the following choices:

Crisis Appointment. These are for students who need crisis services within 24 hours.  If the student needs immediate intervention, the student should be transferred to the crisis person on duty. An example would be consideration of possible 5150.

On campus First Follow-Up.  These are for students who likely need CAPS services and could likely benefit from a course of brief psychotherapy.  If possible, the staff member completing the IA should do the First Follow-Up (FF) and continue with the student throughout their course of brief therapy. This is to maximize continuity of care.  If a staff cannot continue with a student due to scheduling conflict or student preference, the student will be asigned through the Dispostion process (see below).  Consideration should be given to several factors when referring for brief on campus therapy, including positive use of prior therapy, non-severity of prior treatment, high motivation for change, desire for symptomatic relief, presence of situational problem, and ability to be introspective and form relationships with therapist and others.

Disposition.  Staff needing a disposition for a student should enter that students information on the Disposition Roster (Edit Roster on Open Schedule in PnC) and inform management of the need for a disposition.  If a dispostion cannot be determined, the case should be brought to the next CAPS staff meeting for discussion and disposition.

Off campus referral.  These are for students who would likely benefit from open-ended or longer term treatment, and would not benefit from the brief therapy model offered at CAPS.   If a student’s issues require a level of clinical expertise that CAPS staff does not possess or appears to require open-ended therapy, they should be referred off campus.  There may be times when there are few, if any, available CAPS therapy openings and the student has insurance that would cover off campus treatment, in which off campus referral should be considered.  The list of off campus treatment providers, their areas of clinical expertise, and their availability is available on a Drupal database and is updated frequently.  Staff are allowed to carry one long term case throughout the year.  If students need an off-campus referral but one is not readily available or some transition time is necessary, students should be scheduled for a FF.  If the student is unsuccessful connecting to an off-campus therapist and re-contacts CAPS, it is the responsibility of the IA clinician to assist the student further.

Group Screening. Some students may benefit from one of our ongoing psychotherapy groups.  A list of groups and availability is available to staff.  From IA, students will be referred directly to the group leader to set up a screening appointment, and will be admitted to the group if indicated.

Psycho-educational group. Some students may benefit from one of our time limited psycho-educational groups.  These are best for students who appear to have a sub-clinical presentation but could benefit from the information provided in one of these groups (i.e.-study skills).  A list of current psycho-educational groups is available to staff.  A screening is not necessary for a psycho-educational group; students can be given direct information about the group time, location, etc.  Students can also be referred to our Let's Talk program if it deemed they could benefit from a sub-clinical level of service. If students express an interest in our Anxiety Toolbox when first presenting to CAPS, they can be put directly on that roster without the need for an IA.

CAPS Case Management-Students who have recently (within three weeks) been discharged from an inpatient psychiatric facility should have been referred directly to our CAPS Case Manager from the hospital but this is not always done.  If a student identifies as having recently been hospitalized, an appointment can be made with our CAPS Case Manager for further service.

Psychiatry:

In general, our goal is to have students receiving psychiatric care at CAPS to be involved in some form of adjunctive treatment.  This could be individual, group, psycho-ed group, case management, or off-campus treatment.  If a student calls indicating he/she wants medication but has no history of any treatment, the student is given an IA appointment. If the student expresses an interest in transferring their current medication to CAPS, they can be scheduled with the psychiatric case manager. Here are some other scenarios that may lead to other courses of action:

  • ADHD-Students who have previously been diagnosed and treated for ADHD or believe they may have ADHD.  Students will begin services with an IA appointment followed by a FF.  If students have already been diagnosed and treated they should bring a copy of their most recent psychological testing to the intake.  Students can be referred to our website to learn more about our procedure. If deemed appropriate, the student is referred to the ADHD team for ADHD assessment
  • Student currently in off-campus therapy. If students are well-established in off-campus therapy and were referred for or are interested in an evaluation for psychotropic medication, schedule the student directly with the psychiatric case manager. Students need to have their off-campus providers complete the CAPS Psychiatric Referral Form.  The provider should fax the completed form to our office and the front desk will share with the psychiatrist who is scheduled to see the student.
  • CAPS Psychiatric Case Manager-If above students are presenting with complex mental health histories (medications not effective, multiple psychiatric diagnoses, multiple severe psychiatric disorders) refer case to the psychiatric case manager. The case manager will make a determination if the student is appropriate for CAPS psychiatric services or requires a different level or type of service.
  • Direct Psychiatry Referrals-If a student was treated previously by CAPS Psychiatry, the student can be referred directly to one of our psychiatric providers.

Student Health Services. If students are participating in a CAPS IA and appear to have a primary medical concern, they should be referred to the Student Health Center for evaluation. If students appear stabilized on a standard psychotropic medication (s), they should be scheduled to be seen by the psychiatric case manager to assess for suitability to refer to primary care.

III.A BRIEF THERAPY GUIDELINES *

Effective Date: 
Fri, 08/01/2008
Reviewed: 
Mon, 05/07/2018
Revised: 
Wed, 11/01/2017
Policy: 
  1. CAPS offers time-limited counseling with an emphasis on assisting students with exploring issues and resolving concerns so they can achieve their academic goals and be successful in the University. Typically, goals within a brief therapy model can be acheived within eight individual psychotherapy sessions, but the number of sessions can vary based on the individual.  Interns, post-doctoral fellows, and those supervising interns or post-doctoral fellows are allowed to carry one long-term case per year for training purposes. Other staff may also be asked to carry a long-term case as indicated by the needs of the student.
  2. CAPS professional staff contract individually with clients for time-limited solution-oriented individual, couples, or family therapy.   If additional sessions beyond the contract are deemed necessary, the student is provided with appropriate referrals to off campus resources.
  3. Students may not receive individual counseling through CAPS when, in the clinical judgment of the professional staff member and/or a CAPS Management staff, off campus resources are more appropriate for their treatment.  The CAPS staff member will be responsible for explaining the limitations of the services to the client.  The staff member can ask a management team member to sit in on this discussion with the client, if necessary.  If the student is in crisis (danger to self, danger to others, or gravely disabled) CAPS will provide crisis services to stabilize the client consistent with ethical guidelines.
  4. Counseling session allotments are accounted for as follows:  Individual, on-call/crisis sessions, and initial assessment sessions all fall under the client's total individual session allotment. Couples and family counseling, group counseling, and testing sessions are not counted under this allotment.  These are considered adjunct services to the individual allotment.

The following criteria for long-term on-campus counseling must be considered:

  1. The client's issues are sufficiently impairing to warrant the extended use of our services.
  2. The client's issues are not so entrenched that a single year of therapy would be of limited benefit.
  3. The client lacks sufficient financial resources to pursue long term treatment in the private sector.
  4. The client has not utilized the center's services for extended periods in previous years.
  5. Shorter term therapy is likely to be of limited benefit to the client.
  6. The case is determined to be suitable for specific intern training needs, which is determined in consultation with the Clinical Supervisor and/or Training Director.
Procedure: 

While these criteria are intended to be all encompassing, there may be some situations such as clients who meet most of the criteria and are judged by the clinical supervisors to offer an especially good training experience, or clients for whom more extensive therapy will likely facilitate their retention at the University.

Also, group counseling is offered on both a short and long term basis based on clinical appropriateness for the client or the group.

CAPS staff members and interns can request an extension of individual counseling sessions by documenting the request in the client's file and presenting a written request to the Clinical Director.

I.C EMERGENCY PROCEDURES *

Effective Date: 
Fri, 08/01/2008
Reviewed: 
Mon, 05/07/2018
Revised: 
Fri, 08/30/2013
Policy: 

Counseling & Psychological Services (CAPS) follows the emergency procedures of the Student Health Center (Please see Emergency Procedures and Policies under the Health and Safety Section of the Main Policy and Procedures Manual).  A few items specifically relevant to CAPS are detailed below:

  • Code Blue-In the event of a student medical emergency while at CAPS, staff are to press 44 on the telephone to access the pager system and call a Code Blue indicating the location.  This will result in a response by medical staff. Note that the pager system is not heard in all of CAPS.
  • Dr. Slug-In the event a staff member needs physical back-up that does not require calling the police, staff are to press 44 on the telephone to access the pager system and call for Dr. Slug indicating the location.  This will result in a “show of force” from managers present in the Student Health Center.
  • CAPS offices are outfitted with silent alarms.  In the event a staff member is feeling physical threatened, pressing the silent alarm will result in a call to campus police, who will respond immediately.
  • If CAPS staff require back-up from other CAPS staff, they are to call the CAPS Front Desk, at 9-2628, and say they would like to cancel their appointment with Dr. Arnold.  The front desk staff will then contact available CAPS personnel to respond. For staff who are at one of the colleges, front desk staff should ask if the police are needed.  If the answer is yes, front desk will call the police and inform them where to respond.

 

II.P RECIPROCAL ACCESS TO CLINICAL INFORMATION BETWEEN CAPS AND STUDENT HEALTH CENTER *

Effective Date: 
Mon, 08/22/2011
Reviewed: 
Tue, 03/20/2018
Revised: 
Tue, 03/20/2018
Policy: 

To facilitate integrative care and to ensure the highest quality treatment,  healthcare providers at the Student Health Center (SHC) have access to counseling and psychiatry records and CAPS Staff has access to SHC medical records.  These are only accessed as needed to ensure quality care and in accordance with accepted professional practice (clinical need to know and minimal necessary disclosure). Also, Student Health Services Management and billing and insurance staff have access to CAPS records.  All SHS staff are trained on an annual basis on understanding primary care and mental health records and proper access and utilization.  Students will be informed of this sharing of information through informed consent and on our website. Periodic audits of the Electronic Health Record (EHR) will be conducted to ensure that information is being accessed appropriately. If the audit uncovers inappropriate access, disciplinary action will be taken.  CAPS staff will be trained on the use of the "Sensitive Note" within the EHR, to which the SHC staff will not have access.  Students have the right to request not to allow SHC staff access to their CAPS records. In those instances, a form specifying the limits of the confidentiality will be signed by the student and the CAPS Director or designee. Documentation in these charts will be designated sensitive and not accessible to SHC staff.

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