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.