CAPS

III.D INDIVIDUAL COUNSELING

Effective Date: 
Fri, 08/01/2008
Reviewed: 
Wed, 05/27/2015
Revised: 
Wed, 05/27/2015
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 must complete the form requesting a case extension and retain this form in the student's clinical record.  The CAPS staff member will present 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 INTAKE ASSESSMENT

Effective Date: 
Tue, 09/06/2011
Reviewed: 
Mon, 06/26/2017
Revised: 
Mon, 06/26/2017
Policy: 

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

a.       On-campus priority intake.  These are for students experiencing a high level of distress and need to be seen within one to two working days.  A priority intake is available for this purpose most mornings and afternoons.  If a priority intake remains unfilled with less than 24 hours until the appointment, it can be filled with a routine intake. It is expected that the intake therapist will follow-up to ensure student is stable at which time they could provide brief therapy or transitional therapy to connect with off campus services as the situation dictates.

b.       On campus routine intake.  These are for students who likely need CAPS services but are less acute and could wait up to ten working days for an intake appointment and could likely benefit from a course of brief psychotherapy or  transitional therapy to connect with off campus services

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.

3. In the intake 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 initial 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.

III.B PHONE TRIAGE

Effective Date: 
Tue, 09/06/2011
Reviewed: 
Mon, 06/26/2017
Revised: 
Mon, 06/26/2017
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 phone triage procedure (see Front Desk Script in Appendix H).  It is crucial that only true crises go to our crisis service.  An upset student can generally wait for the next phone triage. If students volunteer on the telephone that they are in immediate danger and need to see someone right away they can be given a crisis appointment.  If not, they are to be given the next available phone triage 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 phone triage, the triage person completes a Third Party note, rather than a Triage 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 paper crisis triage form (Appendix A).   If it is positive (the student answers yes to one of the questions on the crisis triage form), they are to be given the next available crisis appointment.  If it is negative, they are to be given the next available phone triage 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 phone triage appointment.

Phone Triage:

The role of phone triage is to direct students seeking services to the level of service they require.  Staff are expected to complete the phone triage form/template (Appendix I) on the student’s Electronic Health Record (EHR) while they are evaluating the student.  Phone triage appointments are scheduled for 30 minutes, which includes time for a 15-20 minute phone consultation/evaluation and note recording.  Students call in to an appointed number at an appointed time.  There is a charge for broken phone triage 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 verbally informed about the phone triage assessment and, if they consent, the interview continues.  Limits of confidentiality are also discussed.

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 15-20 minutes to complete the phone triage, 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 phone triage 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 informed to come directly to the CAPS main office for a crisis appointment. If the student needs services within 24 hours, and no priority intake is available, a crisis appointment should be scheduled in Point and Click.

On-campus priority intake.  These are for students experiencing a high level of distress and need to be seen within two working days, and could likely benefit from a course of brief psychotherapy or need consultation /transitional therapy to connect with off campus services.  If possible, thought should be given to clinical expertise of the intake clinician (i.e.-if student has an eating disorder it would preferable for the intake to be conducted with a staff member with expertise in this area) or the physical location of the intake clinician (if possible and preferable to the student, they should be seen by the staff member who is assigned to their college).  (See Appendices D and E  for clinical expertise and physical location, respectively).  Staff should consult with management prior to scheduling a student in to a priority intake from phone triage as these are typically reserved for students seen in aour crisis service.

On campus routine intake.  These are for students who likely need CAPS services but are less acute and could wait up to ten business days for an intake appointment and could likely benefit from a course of brief psychotherapy.  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.  If possible thought should be given to clinical expertise of the intake clinician (i.e. if student has an eating disorder it would preferable for the intake to be conducted with a staff member with expertise in this area) or the physical location of the intake clinician (if possible and preferable to the student, they should be seen by the staff member who is assigned to their college or specific location).   (See Appendix K for Staff Office Locations)

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, they should be referred off campus.  There may be times when there are few, if any, available intakes 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.  For training purposes, interns 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 referred to a priority or routine intake as indicated.

Group Screening. Some students may benefit from one of our ongoing psychotherapy groups.  A list of groups and availability is available to staff.  From phone triage, 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 for to our Let's Talk program if it deemed they could benefit from a sub-clinical level of service.

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 a phone triage appointment or scheduled with the psychiatric case manager and the case will proceed from there for further disposition.  Here are some other scenarios that may lead to other courses of action:

  • Transfer of Medication CareStudents who are on psychotropic medications and request to transfer their care to us need to be seen by the psychiatric case manger prior to seeing one of the psychiatrists.  After the phone or crisis triage if  clinician determines that transfer of medication care is the main issue, students can be scheduled with the psychiatric case manager for further disposition.  Students requesting a transfer of care do not need a phone triage if they are in current treatment with a psychiatrist. These students should be referred by the front desk to our psychiatric case manager.  Students can be referred to our website to learn more about our transfer of medication care procedure.
  • ADHD-Students who have previously been diagnosed and treated for ADHD or believe they may have ADHD.  Students will begin services with a phone triage appointment and be referred to an intake by the triage counselor.  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.
  • 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.

Student Health Services. If students appear to have a primary medical concern or are stabilized on a standard psychotropic medication(s), students are to be scheduled for a phone triage or seen by the psychiatric case manager to assess for suitability to refer to primary care.  Very routine cases with outside therapy referred for psychotropic medication may also be referred directly to SHC for medication management after assessment by the psychiatric case manager.

III.A BRIEF THERAPY GUIDELINES

Effective Date: 
Fri, 08/01/2008
Reviewed: 
Wed, 11/01/2017
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 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: 
Tue, 05/19/2015
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 ACCESS TO CAPS CLINICAL INFORMATION BY STUDENT HEALTH CENTER

Effective Date: 
Mon, 08/22/2011
Reviewed: 
Mon, 09/30/2013
Revised: 
Mon, 09/30/2013
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. Also, Student Health Services Management and billing and insurance staff have access to CAPS records.  All SHC staff are trained on an annual basis on understanding 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 the student and the CAPS Director or designee. Documentation in these charts will be designated sensitive and not accessible to SHC staff.

II.O WELFARE CHECKS

Effective Date: 
Mon, 08/22/2011
Reviewed: 
Wed, 05/27/2015
Revised: 
Sun, 08/28/2011
Policy: 

In certain clinical situations, a CAPS clinician may want to institute a police welfare check when they are concerned about the imminent safety of a client.  A police welfare check is a process by which law enforcement can go to an individual’s residence in order to determine if a person is in significant distress or in need of assistance because of a health condition.  A CAPS staff member may request that a welfare check be conducted for high risk clients who, in the clinician’s judgment, may be at imminent risk to themselves or others.   A Release of Information is not needed when requesting a welfare check for the imminent safety of the student or others.

In order to initiate this process, the following steps are followed:

  1. The treating clinician will consult with a licensed senior staff member of management team member prior to contacting the police.
  2. If the student lives in on-campus housing, the UCSC campus police are contacted to conduct the welfare check
  3. If the student lives in off-campus housing, the Santa Cruz city police are contacted to conduct the welfare check.
  4. The consultation and contact with the appropriate police department will be documented in the clinical record.

II.N REQUEST FOR RECORDS

Effective Date: 
Fri, 08/01/2008
Reviewed: 
Wed, 05/27/2015
Revised: 
Wed, 05/27/2015
Policy: 

Clients are entitled to receive or review their record when this is "in their best interests" and would not be likely to cause "substantial harm."  The clinician reviews the record to determine if anything in it would, in her/his judgment, likely cause "substantial harm" as indicated by tangible and serious negative outcome, e.g. injury to self or others, not just emotional upset. Records are released in accordance with professional standards and regulatory guidelines.

Procedure: 

1. If a client requests a copy of their record they must follow the procedures listed below:

i.       The client is required to request the records in writing and must sign a release of information form.

ii.      CAPS will, if appropriate, provide the client with a summary of their records or the entire record if requested.

iii.    If providing the records is deemed inappropriate CAPS will, after court order or request of the client, forward a copy of the records to a licensed mental health professional designated by the client

If the likelihood of harm as a result of disclosure may not be satisfactorily addressed through a staff person reviewing the records with the individual then:

1.)     The denial and reasons for it are reviewed with the individual; and

2.)     The denial and reasons for it are noted in the individual's record.

iv.     If a client wishes to see their records after they have read the summary and it is deemed appropriate for them to do so they may read the file in the presence of the CAPS Director or designee.  A copy of the file may be made at the client's expense.

2. Time guidelines for release of records:

i. Review of records-Five working days

ii. Treatment summary-Ten working days

iii. Copy of records-Fifteen calendar days

iv. Complex treatment summary-Thirty calendar days

II.M DOCUMENTATION OF CLINICAL CARE

Effective Date: 
Fri, 08/01/2008
Reviewed: 
Wed, 11/01/2017
Revised: 
Wed, 11/01/2017
Policy: 
  1. All clinical interactions with patients are documented by CAPS professional staff with a signed, contemporaneous note in the medical record in accordance with professional standards and regulatory guidelines.
  2. Clinical documentation is accurate and completed in a timely manner.
  3. Clinical records are maintained in an electronic medical record with security features that preserve privacy but allow timely viewing by health care practitioners with appropriate permissions.
  4. Unlicensed staff and trainees require the co-signature of their supervisor for all clinical documentation.
  5. The electronic record provides the time and date when notes are electronically signed. Notes written on a subsequent date are dated with the actual date of signature, even if referring to an earlier interaction. 
     
Procedure: 

1. Crisis Notes:

  • Licensed Staff-Crisis services provided by licensed staff need to be documented within one working day.
  • Unlicensed Staff- Crisis services provided by unlicensed staff need to be documented within two working days, to allow time for review by licensed staff.
  • 5150 cases-If a student is involuntarily psychiatrically hospitalized from CAPS, documentation must be completed by the end of the day.

2. Non-Crisis Notes

  • Licensed Staff
    • Initial assessments must be completed within three working days of the service
    • Follow-up notes must be completed within two working days of the service
  • Unlicensed Staff- Review of the record and co-signature by supervisor for non-crisis services must occur within 5 working days of providing the service.

3. ADHD Assessments

  • Due to the time needed to complete, review, analyze, document, supervise, and co-sign the results of an ADHD assessment, staff have 10 working days from completion of testing to finalize documentation.

 

4. Content of clinical entries include, at minimum:

  • Date of service
  • Provider name and title
  • Chief complaint or nature of visit, with appropriate history
  • Objective clinical findings
  • Diagnosis, assessment or impression
  • Treatment plan documentation
  • A history of serious suicide attempt(s), dangerousness to others, or major alcohol/other drug (AOD) problem(s) are documented in the Clinical Comment section with the following codes, with reference to the date of a CAPS note that describes the problem:
    • History of serious suicide attempt(s) or dangerousness to others: “Hx (see x/x/xx note)
    • Major AOD problem(s): “Rx (see x/x/xx note)
  • Therapies administered or recommended with discussion of necessity, risks, and alternatives as appropriate

 5. Initial assessment/first follow-up notes will include:

  • Relevant history including- history of present illness, history of past psychiatric, medical and substance use problems, brief family history, academic/employment history
  • Mental status examination
  • Risk of harm to self or others
  • Known or potential addictive behaviors and substance abuse
  • Client self-understanding, motivation, and decision-making
  • Diagnosis, assessment, or diagnostic impression
  • Plan, including any medications prescribed.

6. A new first follow-up should be completed if it has been more than one year since the last visit. At the clinician’s discretion, a firwt follow-up note may be added to the chart when a student sees a new provider, or if there has been a significant lapse of time or change of condition since the last visit.

7. Termination of services will occur under the following circumstances:

  • Mutual agreement between provider and student
  • Student referred for off-campus treatment
  • No further contact is received from the student after outreach

8. Termination will be documented in the student’s EHR and will include:

Dates of service, diagnosis or diagnostic impression, level of risk at last contact, treatment administered, number of sessions, change in symptoms, disposition, and any final revisions to the Clinical Comment entries made by CAPS.

A clinical record can be terminated when the treatment is completed or at the end of the academic year at the discretion of the clinician.  Cases are terminated when students leave the university, treatment is completed, treatment is transferred to a provider off-campus, or are no longer eligible for services through CAPS.

Written terminations are done for individual therapy.  For group, a summary can be provided in the last group documentation.   If only an intake was conducted, a case management note for termination is sufficient.

Formal terminations are not required for psychiatric services as they are open-ended and students often start and stop treatment.  Psychiatric staff can choose to complete a termination form.

9. Telephone contact with a patient is clearly identified as such in the medical record and content of the call is noted in the EHR, with appropriate clinician signature.

10. Documentation errors are corrected using addendums to the note unless the documentation was entered into the wrong patient's chart in which case follow the Medical Records Standards policy & procedure: XI. Corrections and Amendments to Records

11. Messages about clients to other CAPS staff are sent using the secure message system. The secure message system has more stringent security features than campus email.  Campus email is not used for protected health information.

12. Security of Mental Health Records - Health practitioners lock the computer screen prior to leaving the treatment room and screens automatically time out after 5 minutes if they inadvertently forget to lock the screen. Reminders to lock the screens are found on the work station. Paper protected health materials are collected throughout the day and locked up at the end of each day in the alarmed medical records office.

Key Points: 

 

  1. Documentation of clinical care occurs in the patient’s electronic health record.
  2. Documentation occurs in a timely manner, using standard clinical format.
  3. Documentation errors are corrected using addendums to the note unless the documentation was entered into the wrong patient's chart in which case the medical records administrator can clear a note from an EHR.
  4. Security features to assure the safety of protected health information include the lock-out features in the EHR and regular collection of paper materials for storage in the locked Records office.
     

 

 

 

II.L RELEASE OF INFORMATION (PROVIDING DOCUMENTATION OF THERAPY SESSIONS TO A THIRD PARTY)

Effective Date: 
Fri, 08/01/2008
Reviewed: 
Wed, 05/27/2015
Revised: 
Fri, 05/29/2015
Policy: 

 

  1. In order for a student to be given a summary of services inclusive of a clinical opinion to a third party, the clinician must believe he/she has had enough time to form an accurate clinical impression of the student.
  2. CAPS staff can document client behaviors, clinical observations, symptoms, or prognosis to a third party with the appropriate release of information.  However, CAPS staff does not make recommendations about administrative concerns or decisions.  This would include decisions about academic status, removal or separation from school, housing or dining hall contracts, or participation in extra-curricular activities.
  3. CAPS staff should consult with a CAPS Management staff if providing documentation to third parties outside of the University related to background investigations, career, job, or internship acceptability, or appropriateness for certain job activities.
  4. When requests come from former clients regarding release of information pertaining to counseling services, standards of practice are used including obtaining informed consent and completion of Request of Information form from the client.
  5. CAPS staff who are licensed may submit clinical documentation to the Disability Resource Center (DRC) for students requesting academic accommodations if the clinician believes he/she has had enough time to form an accurate clinical impression of the student.  A consent for release of information must be obtained.
  6. CAPS staff who are licensed may submit clinical documentation for students requesting a medical leave (Request for Medical Information form) if the request is appropriate.
  7. Unlicensed staff and trainees must consult with their supervisor or another licensed staff member before submitting any documentation and documentation must be co-signed by the designated supervisor.
     

 

 

 

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