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


  1. If a client contacts CAPS about dissatisfaction with CAPS services or gives negative written feedback and identifies themselves, the CAPS Director or designee communicates directly with the client.
  2. The CAPS Director can present several options to the dissatisfied client in an attempt to resolve their complaint or concern.  The client can discuss their concerns solely with the CAPS Director; the client can be encouraged to discuss their concerns directly with their therapist; the client can meet with both the CAPS Director and their therapist; or the client can be provided with appropriate resources and referrals.
  3. A client may discuss dissatisfaction with the CAPS Director or with a designee of the director.  If they cannot resolve the issue, along with informed consent from the student, the issue can be discussed with the Executive Director of Student Health Services.
  4. Complaints and grievances will be logged by the CAPS management team and analyzed on an annual basis (or as needed) to determine the need for any changes to overall policy or personnel.






Effective Date: 
Fri, 08/01/2008
Tue, 04/17/2018
Tue, 04/17/2018

1. Referrals to Off-Campus Providers

Referrals are made to private therapists, private psychiatrists, or community agencies when the treatment of choice is not available through CAPS or when individuals are not eligible for services.  The list of off-campus treatment providers, their areas of clinical expertise, and their availability is maintained in a database and is updated frequently.                                         

If at all possible, at least three referral names are provided.  Students are either told the referrals names during their contact with CAPS clinician, sent the names in a secure message on their Student Health Communicator, or provided a list when they come in to pick up their referral form (if applicable).  It is the referring clinician's reponsibility to determine the level of follow-up necessary to ensure student's connect with an off-campus provider, and provide whatever follow-up is indicated.  In the event the referral becomes complex, a case management referral can be made.  In the event a student is endorsing concerning risk factors, the referring clinician should continue to follow the student until a successful referral is made, and attempt to secure a release of information for the referred to clinician. Depending on acuity, the clinician can choose to send a letter to the client’s last known address, in the event the student does not follow-thru on referral recommendations.

Students who do not endorse any concerning risk factors require no follow-up.

To ensure continuity of care, every effort should be made to secure a Release of Information (ROI) when an at-risk student is transferred to an off-campus provider or facilitity.  Similarly, when the treatment of a student is shared between CAPS and an off-campus provider or facility, an effort should be made to secure an ROI to help coordinate care.  If there is no ROI in place, a FERPA Health and Safety Emergency Exception, or HIPAA Care Coordination provision may be implemented if indicated.

2. Undergraduate and Graduate Insurance (USHIP/GSHIP)

If a student is referred off-campus who has the student health insurance, the CAPS clinician making the referral must complete an Off Campus Referral form in the electronic health record.  The student then brings this form to their off campus appointment.

a. A New referral form is the first referral form given to a student for psychological treatment.  A Renewal referral form is any form given after the initial New referral form expires and the student continues to need treatment.

b. All insurance forms expire just prior to the beginning of Fall Quarter in September.  Renewal referral forms are needed at this time for continued coverage.

c. CAPS may back-date renewal referral forms if the student’s file contains documentation of a prior referral within the past year.  This is done when students request a renewal referral form after coverage has already expired.

d. Student insurance referral forms must be requested by the student.  CAPS will not process or release a referral form for anyone but the student.

e. Students can contact CAPS through phone triage to get a referral.  The referral form can be sent electronically to the student through the Health e-Messenger system if "Prepare PDF" is selected by the clinician.  The student can also come to the main CAPS office to pick up a referral form.  At that time, an electronic copy of the referral form is automatically sent to the insurance company.  Students are given a copy of the referral, which they need to bring in to the off-campus clinician.

f. Off campus Providers do not need a copy of the insurance form to be paid by the insurance company.  The copy is given solely for the clinician’s record.

h. CAPS does not mail or fax clinicians copies of new or renewal referral forms.


Effective Date: 
Fri, 08/01/2008
Mon, 05/07/2018
Thu, 01/11/2018

1. When a client does not show for an appointment, it is the responsibility of the CAPS clinician with whom the appointment was made to arrange for follow-up.

2. An exception to this exists when a student misses a first time Psychiatry appointment.  If the student was referred to Psychiatry by a CAPS clinician, the Psychiatrist will send an Instant Message via the Electronic Medical Record and copy the referring clinician on the Missed Appointment note in the Clinician Record.  It is the responsibility of the referring clinician to follow up with the student.  If the student is referred to Psychiatry from an off-campus clinician and a Release of Information is on file, the Psychiatrist will notify the referring clinician regarding the missed appointment.

3. Coordinating follow-up by the responsible clinician:

a.  The Clinician personally arranges the follow-up & documents the plan.

i. If the Clinician is unable to contact the student after 2-3 attempts, the clinician will need to document if further efforts at contact should be made or if the case should be terminated.

ii. The clinician will consider sending a registered/certified letter, instituting a welfare check - or breaking confidentiality and contacting a family member, if the safety of the student is at risk. Whenever the clinician considers instituting a welfare check or breaking confidentiality, they should first consult with senior staff or management

b. If the follow-up arrangements can wait until the next day, the Clinician can choose to have follow-up arranged by front desk staff:

i. The Clinician IMs “Missed Appointment Note” including specific instructions as to the type of follow-up appt needed, (i.e. First Follow-up, Psychiatry Follow-Up) and within what time frame, to the Front Desk Support staff member who will facilitate contact with the student.

ii. If the Appt. Scheduler is unable to contact the client after 2 attempts, the Scheduler IMs the Clinician informing him/her.

4. A CAPS client who does not show for an appointment will be charged $25.  The first time a student misses an appointment the charge is waived. If a client comes late to an appointment, they may be charged a missed appointment fee:

a. a no-show charge will be assessed when students are more than 20 minutes late to ininitial assessment or full-length therapy sessions.

b. for brief sessions (20-30 min) or 30 min psychiatric med checks, students will be charged if more than 15 min late.

5. Any exceptions to this policy must be made by managers.



Effective Date: 
Fri, 08/01/2008
Thu, 01/11/2018
Mon, 06/26/2017

Post-hospitalization services are the responsibility of the student’s primary clinician, including CAPS staff clinicians and off-campus clinicians, in collaboration with the CAPS Case Manager. When the student has no pre-established primary clinician, post-hospitalization services are the responsibility of the CAPS Case Manager.  Post-hospitalization procedures are as follows:

1) Collaboration and Consultation regarding hospitalized students.

a. All 5150 cases are sent to the area Crisis Stabilization program (CSP).  Many students are released within the 23 hour hold period. Those who are held for a 72 hour hold are typically transferred out of county.  Depending on the facility, information can be difficult to obtain.  Some units will fax student’s admittance and discharge paperwork to the Case Manager upon the student’s discharge from the hospital.

b. Students who were unable to sign release of information forms prior to hospitalization and who want CAPS assistance may sign consent forms while hospitalized.

c. The CAPS clinician will facilitate the notification of and collaboration with other treatment providers, campus units, friends, and family members of the student with appropriate consent forms.  With appropriate consent forms, the CAPS clinician will request that academic staff notify the student’s professors of the student’s absence.  Unless otherwise specified by the student, professors should be told the student has had a “medical emergency.”

d. The CAPS clinician will maintain frequent phone contact with hospital staff to collaborate on discharge and treatment planning.

e. The CAPS clinician will pass all information regarding hospitalized students, including hospital paperwork, to the referred to CAPS psychiatrist.

2) Direct Service

a. The CAPS clinician will call the student as soon as possible after discharge from hospitalization to schedule an appointment for crisis assessment, stabilization and follow-up treatment planning.  This meeting includes:

i. Assessing risk-factors

ii. Crisis Stabilization

iii. Developing a safety plan

iv. Psychoeducation on the student’s diagnosis and treatment options

v. Referral to on and/or off-campus treatment services

vi. A follow-up plan for on-going clinical and case management services

b. With appropriate consent forms, the CAPS clinician will meet with the student and his/her available supportive others.  This is to help ensure the facilitation of the treatment plan, and to provide psychoeducation and support to the student’s family and friends.  The student’s family and friends may need referrals for their own treatment services.

3) Goals for follow-up treatment plan after initial assessment.

a. Facilitate transition back to school if appropriate

b. Facilitate Withdrawal or Leave of Absence if appropriate

c. Facilitate resolution of housing issues

d. Facilitate getting basic needs met

e. Facilitate mobilization of support network

f. Facilitate access to on/off-campus services including therapy and medication management.


Effective Date: 
Fri, 08/01/2008
Wed, 03/21/2018
Wed, 03/21/2018

Procedures for Involuntary Hospitalization (5150 Hold):

Students requiring a referral for a 5150 Hold will be transported to the Santa Cruz County Crisis Stabilization Program (CSP) for an evaluation by the Psychiatric Emergency Services staff to determine if treatment as an involuntary hospitalization is indicated.  Students can be held in the CSP for up to 23 hours prior to transfer or release.  The transportation for students without a physical health emergency is provided by the UCSC Police Department.  Transportation for students experiencing a physical health emergency is done via ambulance to Dominican Hospital. The charge nurse at the Student Health Center should be informed of these CAPS initiated physical health transfers to Dominican. The CAPS licensed staff member  initiating the involuntary hospitalization will complete the following steps:

·         Consult with one or more licensed staff members, always including a member of the management team, to review the case and make a collaborative decision as to whether involuntary hospitalization is clinically indicated.  If a clinician in a satellite office is considering initiating a 5150 hold, consult with CAPS management (CAPS management might come to the satellite office to facilitate the 5150 hold).   CAPS management representative should consult with other available CAPS managers about 5150 decisions.

·        A member of CAPS Management staff (who is certified by the county to write 5150 holds) completes the form for up to 72-hour Detention For Evaluation and Treatment  in consultation with the staff clinician. The CAPS Management staff writing the 5150 will also give the advisement to the student per 5150 requirement.

·        In urgent situations, such as a medical emergency or a flight risk, contact the PD through the emergency telephone number, 9-2345, or dial 911 from a campus phone. For urgent medical situations in the Central offices, also use the Code Blue procedure (see SHC EMERGENCY ANNOUNCEMENT PROCEDURE/PAGING SYSTEM procedure in the Main Manual). If there is a non-urgent medical concern, contact a Student Health Center clinician, CSP staff, other licensed CAPS staff, and/or medical emergency services to consult regarding the need for police vs. ambulance transportation to the CSU.  The CAPS staff member will contact Campus Police, identify her/himself and request officer assistance and/or ambulance services depending on the circumstances.  The Campus PD non-emergency telephone number is:  9-4856.

·         It is the policy of the Campus Police Department that students requiring transportation for an involuntary hospitalization will be handcuffed for safety purposes. The CAPS staff member initiating the 5150 Hold will inform the student of the Campus Police Department’s handcuff policy prior to being handcuffed, except when doing so could create a safety concern.

·         Time-permitting, the CAPS  staff member will request of the student his/her consent (utilizing a Release of Information form) to contact anyone who may contribute to the student’s treatment and stabilization.  This may include but is not limited to parents, campus housing staff, campus academic staff, friends, and other family members. The CAPS staff member or management will call the CSP to inform the Psychiatric Emergency Services worker that the student is being transported to their unit, and provide necessary information to ensure the student’s safety.  That telephone number is: 831-600-2800If the student is being sent to an Emergency Room for medical evaluation, CAPS staff should call the ER to let them know the student is coming.

·         CAPS staff will only inform the person(s) who the student has given consent to inform unless breaking of confidentiality is necessary to ensure the student’s safety, as a health and safety or legitimate educational interest FERPA exception.  Calls to family and other people involved in the immediate stabilization of the student will be done as soon as possible and always on the same day of the hospitalization.


·        Procedures For Voluntary Hospitalizations:

Students presenting with serious risk factors which do not rise to the level of imminent risk  may benefit from psychiatric hospitalization and can be assisted by a CAPS staff member for a voluntary admission to a local in-patient psychiatric facility.  Campus police will not transport for a voluntary hospitalization. CAPS can suggest a family member, taxi voucher, or whatever is appropriate for the situation. Some possible voluntary hospitalization options are:

·         Good Samarian Hospital, San Jose, CA, (408) 559-2011

(15891 Los Gatos Almaden Rd., Los Gatos, Calif. 95032)

·         CommunityHospital of Monterey, Monterey CA, (831) 625-4623

(23625 Holman Highway, Monterey, Calif. 93940)

·         El Camino Hospital Mountain View (650) 940-7291

(2500 Grant Road, Mountain View, Calif. 95040)

·         Stanford Hospital, Palo Alto, M-F 8am-5pm (650) 725-9848, nights and weekends (650) 723-4000, (401 Quarry Road, Palo Alto, Calif. 94305)

·         Kaiser San Jose, (previously called Santa Teresa), no inpatient Psych unit, they contract out to other private hospitals. Behavioral Medicine (408) 972-6442, Psychiatry outpatient clinic (408) 972-3095, Kaiser Regional Psychiatry Center (925)372-1103. (250 Hospital Parkway, San Jose, Calif.) Kaiser is in Santa Clara as well: 3840 Homestead Rd, Santa Clara, (408) 851-4850.

Voluntary hospitalization requires appropriate insurance or ability to pay for the services by the student or the student's family.  Obtaining the student's consent to contact appropriate family members or other emotionally supportive persons is always recommended.  If there are imminent risk factors such as suicidal intent or homicidal intent caused by a mental illness, a voluntary hospitalization would not be appropriate and a 5150 Hold must be initiated.

5150      Initiated by Non-CAPS Staff

·         Student hospitalization initiated by campus police or a non-campus agency (SCPD, SC Sheriffs Office, etc.)

CAPS staff will not be notified by initiating professional, but may be contacted by any campus staff or faculty who is aware of the hospitalization.  Additionally, the CSP may notify the CAPS Case Manager and/or CAPS Crisis Services Staff when any student is evaluated by their service.

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