II.B CRISIS PROCEDURES - OVERVIEW

Effective Date: 
Fri, 08/01/2008
Reviewed: 
Mon, 06/26/2017
Revised: 
Mon, 06/26/2017
Policy: 

Brief Risk Assessments:

All registered UCSC students who present to CAPS Central Office during normal business hours (Monday through Friday from 8 AM until 5 PM) and are perceived to be at risk or in an acute crisis are eligible for a same day, brief risk assessment at no charge. Brief risk assessments are designed to assist students who are confronting life-threatening circumstances, current or recent traumatic event(s), or serious mental illness. Examples of such issues include:

  • suicidal thoughts
  • the need to be hospitalized for mental health purposes
  • thoughts about harming another person
  • recent assault or abuse
  • concern about their safety or someone else’s safety
  • hallucinations or other “odd thinking”
  • recent death of a loved one
  • witnessing or experiencing a traumatic event
  • adverse drug reaction

Consultations:

CAPS provides in-person and telephone consultations to students, staff, faculty, and parents who are concerned about UCSC students who might be in emotional or psychological distress. See Third Party Contact/Consultations Policy

After Hours Crisis Service and ProtoCall:  

After business hours, during weekends and on holidays, ProtoCall (an off-site privately contracted company) provides telephone crisis assessment, safety planning, and referrals for UCSC students. This service is accessed by phoning the CAPS Central Office at (831) 459-2628 and selecting the “After Hours Crisis Services” menu option. All members of the UCSC community (students, staff, faculty and parents) may utilize this service to obtain immediate, telephone-based consultation and support regarding a variety of crisis issues, and to facilitate transitions to CAPS daytime services. Each business day, CAPS staff review new ProtoCall contacts and respond accordingly. See After Hours Service and ProtoCall Policy.

If needed, a ProtoCall provider may contact CAPS clinician(s) or other UCSC officials to mobilize campus and community resources. The primary CAPS clinician on-alert for ProtoCall contacts is generally available by cell, and is not required to be in a specific geographic location while on-alert. If the primary CAPS clinician on-alert is not available, ProtoCall will contact another member of the CAPS counseling staff and/or management.

Procedure: 

Students who are referred, or self-refer, to crisis services need to complete the crisis triage form (Appendix A).

Positive Crisis Triage Form:

Students who endorse one of the questions on the crisis triage form are given the next available crisis appointment.

For students who complete the crisis triage form and endorse the item, “I am having a severe reaction to a psychiatric medication,” only (i.e., no other items on the crisis triage form are endorsed), front desk personnel will inform students they may utilize one of three options: (1) schedule a same day crisis appointment, (2) present to the SHC’s Same Day Clinic, (3) schedule a phone triage appointment.

For students who complete the crisis triage form and endorse the item, "I attempted suicide within the last 24 hours," all other preliminary steps are bypassed and the student is seen immediately by the crisis staff or management backup.  If the student had recently ingested a toxic substance, or is otherwise in immenent physical risk, UCSC police dispatch will be contacted immediately and, if indicated, student will be taken to the local emergency room.  If there is a delay, the Medical Director (or designee) can be contacted for their assistance.

For students who endorse one of the questions on the crisis triage form yet decline a crisis appointment, or who express a desire to leave prior to their crisis appointment, the front desk personnel will encourage the student to attend a crisis appointment. Additionally, whenever possible, the front desk personnel will inform a CAPS clinician of the student’s imminent departure or disinterest in an appointment. If a student continues to decline an appointment, the student will be given the CAPS Walk-Out Letter (Appendix B) and be invited to contact CAPS for a crisis appointment. As needed, following the student’s departure, the CAPS clinician will consult with additional CAPS providers to determine appropriate courses of action aimed at minimizing the risk of harm or injury.    

Negative Crisis Triage Form:

Students who do not endorse a question on the crisis triage form are offered the next available phone triage appointment.

Students who do not endorse questions on the crisis triage form yet express a strong urgency to meet with a crisis counselor for a same day appointment will meet with a CAPS clinician for a “brief consultation.” During the “brief consultation,” the CAPS clinician will ascertain and inform front desk staff whether the student’s concern(s) warrant a same day crisis appointment or a phone triage appointment.

Brief Risk Assessment:

For same day crisis appointments and “brief consultations:” Prior to meeting with a CAPS clinician, front desk personnel will provide students with: (a) the Informed Consent and Notice of Privacy Practices Form –(Appendix C), (b)  the “Same-day Crisis Assessment and Consultations” informational sheet (purple paper) (Appendix E). Additionally, for same day crisis appointment, students will compete the Student Questionnaire form (Appendix F), and the CCAPS.

Upon meeting with a CAPS clinician: The CAPS clinician will inform the student of the limitations of confidentiality and conduct a brief risk assessment.  Following the risk assessment, the clinician will provide an appropriate level of crisis management and intervention services. In collaboration with the student (and/or other Student Health Services providers—CAPS; primary care), the clinician will identify an appropriate treatment and service plan (e.g., CAPS priority or routine intake appointment; crisis follow-up appointment; hospitalization; on- and/or off-campus referral services; personal action plan). See relevant subsections of the CAPS Policies and Procedures Manual for additional information on the aforementioned clinical, counseling and psychiatric services. Guidelines specific to crisis follow-up(s) are outlined below.

All crisis assessment, management, and intervention services are delivered in accordance with professional standards and regulatory guidelines, and follow usual and customary care practices.

 Crisis Follow-up Appointments:

Depending on the outcome of the brief risk assessment and time frame for follow-up treatment and services (e.g., the availability of priority appointments; days prior to appointment with an off-campus provider), the crisis clinician may conduct an in-person and/or telephone crisis follow-up appointment.  Each crisis follow-up appointment should involve a risk assessment and check-in regarding the treatment and service plan documented during the previous crisis contact.

For information on managing and documenting missed crisis follow-up appointments, see the Missed Appointments section of the CAPS Policy and Procedures Manual. 

Documentation:

All crisis service related forms and clinical interactions with students are documented in students’ Electronic Health Record (EHR). Crisis Assessments are to be completed within 1 business day by licensed staff. Crisis assessments completed by unlicensed staff must be reviewed and signed by a licensed CAPS clinician within 2 business days. See section II M, Documentation of Clinical Care