APA Accredited Internship in Clinical and Counseling Psychology
Introduction to Clinical Services
I. Scheduled Clinical Procedures
a. Triage/Screening Appointments
When students call or come into the Cook Counseling Center and ask for an appointment they are scheduled for a 15 minute appointment with a therapist. This could be initiated either over the phone or in-person. This first appointment is a triage/screening appointment to assess if Cook Counseling Center services are appropriate for the presenting problem, and if so the most appropriate services that we offer are suggested. Students are triaged in that those with the most severe or debilitating problems are scheduled sooner and those with less severe problems may have a longer period to wait before their scheduled appointment.
Those students that are not appropriate for our services may be referred to an off-campus provider. The most appropriate provider for each student will be suggested and the student can be assisted in the scheduling process.
If the triage session identifies an emergency situation that needs to be further assessed or dealt with on that day the student will be scheduled for an emergency appointment with yourself, if possible, or with an emergency counselor for that day if you do not have any time available. Emergency situations may include anytime a threat to the student or someone else may exist. These may include but are not limited to instances of suicidal or homicidal threat, psychotic symptoms and/or manic symptoms.
If the triage session indicates that an appointment with a therapist would be the most appropriate treatment intervention the student is referred back to the front office staff for scheduling of an intake (or update if the students was seen at the Cook Counseling Center in a previous year) appointment. The therapist should inform the front office staff when the appointment should be made (length of wait time). The appointment should be made with the therapist completing the triage session, if possible. If the student is currently seeing another therapist the student will be referred back to that therapist.
b. Intake/Update Appointments
Clients present to the front office and are directed to the small room in the lobby to complete screening information online via one of the four computers in the office. First, students read a letter of welcome from the director, followed by information about their rights as a client. They are presented with statements about the limits of confidentiality and are asked to sign, verifying that they have read about these limits. Finally, they indicate demographic information and information about symptoms on the final screens and are asked to print this information. Once they have pressed print, the front office staff members create a hard copy and places this in a file for you to pick up when you see the student.
Therapists know that students are ready for their appointments when their names turn blue and flashing on the electronic scheduler called “Medicat”. Once a therapist sees the name change color on the scheduler, s/he goes out to the front office to get the chart (behind the right hand desk in the rack on the door) and by using the first name only of the client, greets the student in the lobby and escorts him/her to the therapy office.
c. Eligibility for Service
A student is appropriate for services at CCC if:
· S/he is enrolled in classes at the time s/he is seeking services and has paid the Student Health Fee (graduate students doing research on campus may be eligible if they pay the student health fee even if not taking classes)
· The presenting issues can be addressed with short term therapy
· The presenting issues are appropriate for group therapy or a skills workshop
· S/he is in need of crisis management-stabilization
A student is not appropriate for services at CCC if:
· S/he is not enrolled in classes at the time s/he is seeking services and has not paid the Student Health Fee
· The presenting issues are obviously longer term issues that will require long term and/or weekly sessions
·
d. Documentation of Appointments
All appointments are recorded on Medicat. A “ticket” is completed for screening and continuing clients. Medicat also keeps appointments scheduled for continuing clients.
1. Tickets
Tickets are completed within the Medicat system for every appointment. They serve to document a student’s visit to the CCC as well as provide a method of tracking the services that each person has received. To create a ticket, single click on the individual’s name on the daily schedule. Next, single click on “ticket” on the top bar of the program. This will bring up a new screen on which you can indicate the treatment provider, diagnosis, date of service, and transaction (e.g., intake, triage, couples therapy). Once those items have been completed, a ticket is “posted” by clicking on the “post item” icon and then saved in the system by clicking on the “save item” icon. Printing a ticket is not necessary.
2. Scheduling
There are several different kinds of appointments or “blocks” that can be scheduled within Medicat. To begin, click on the day on which you would like to schedule an appointment. Click on the hour that the appointment begins. That 15 minute block will be highlighted in blue. Choose “block” from the top bar of the program. On the next screen, you can specify the type of appointment (block, reservation, group reservation, or template), time (beginning and end), color of the block, reason (therapy, sick leave, individual supervision, etc) date range (for recurring appointments), and additional people who will be included on the schedule (useful when scheduling group meetings).
Most appointments will be considered “blocks”. This includes supervision, meetings, and therapy hours. Reservation blocks are used for triages.
II. Daytime emergencies
Each therapist provides 1 hour of daytime scheduled emergency coverage per week. These will be scheduled within Medicat and typically do not change from week to week. The therapist should be available for emergencies that may evolve at anytime on that day. On any given day, there are approximately 2 hours of daytime scheduled coverage available for emergencies. Others may be fit in.
If you meet with a client who presents to the CCC with an emergency as described above, usually in triage, you may schedule an emergency appointment for the student in crisis. If you have time available you can schedule the appointment with yourself or you may schedule the student with another therapist who is providing emergency coverage for that day. It is customary to inform that person that they have an emergency appointment scheduled as well as to provide them with the file and case notes for the individual. Suicidal and homicidal situations should be evaluated as stated below in “After hours emergencies” but can be evaluated at the Cook Counseling Center.
III. After hours emergencies
You will either be paged on the pager or called on the Cook Counseling Center cell phone. Call the number back that is listed on the pager. Usually, it is the answering service or an on-call administrator from Residence Life. If they want you to assess a student, complete a triage form for that student while on the phone. If you feel you need to further assess the student before making a recommendation or if the student identifies suicidal or homicidal intent you will need to meet the student at the Virginia Tech Campus Police Station (on Southgate Drive).
If the student is not willing to talk or meet with you and you or the person calling you has reason to believe the student or someone else is in danger you can recommend that the student be assessed by ACCESS (Community Services Board) (phone 961-8400) involuntarily.
If you will be meeting with the student, call the Virginia Tech Campus Police (231-6411) to let them know you will be using their facilities. They can pick up a student at their residence hall or apartment if a ride is needed. You can meet with the student in a private room in the police station or with a police officer present if you feel safety is an issue.
IV. Procedure for hospitalizing a suicidal or homicidal client
The Counselor/Psychologist should complete a thorough suicide and/or homicide risk assessment. If the Counselor/Psychologist determines that the client will not be safe until the next scheduled meeting then hospitalization or in rare occasions other appropriate supervision should be arranged.
With the student’s permission, or if in the Counselor’s/Psychologist’s clinical opinion it would be best to contact the student’s parent(s), this can be initiated. If the Counselor/Psychologist believes the student will be safe with a parent present this may arranged with the parent. Any risk associated with this should be discussed with the parent.
If the student does not have insurance or is unwilling from the onset to be admitted to a psychiatric hospital ACCESS (961-8400) will need to be called for involuntary hospitalization or hospitalization at a state facility. ACCESS will complete their own assessment on the student at the Cook Counseling Center during normal business hours or at the Virginia Tech Police Department if after hours. If they determine that the student does not need to be hospitalized but the Counselor/Psychologist disagrees with this assessment, it should be clearly communicated to the ACCESS worker.
If the student is agreeable, the Counselor/Psychologist should discuss voluntary hospitalization with the student. CONNECT (a mental health admittance and referral service for Carilian Health Care and Roanoke Memorial Psychiatric Services) at 540–731-7385 or 1-800-284-8898 can be called. RESPOND (a mental health admittance and referral service for Lewis Gale Hospital and Montgomery Regional Hospital) at 953-5324 may also be called. In this case, the person will be evaluated at Montgomery Regional Hospital and will be transported by ambulance (at the student’s expense) to Lewis Gale Hospital in Salem. The facility that accepts the student’s insurance would be the best choice. The Virginia Tech Rescue Squad (231-7138 or 231- 7984) has agreed to transport students to Montgomery Regional Hospital or Carilion Health Care.
If the student is being admitted on a voluntary basis, before the student leaves for the hospital:
1) Make sure you have contact information from the student (phone, address, e-mail).
2) Have the student sign a release of information for the admitting hospital in order for the Counselor/Psychologist and hospital to exchange information about the student if needed.
3) Write a summary of your contact with the student and reason for hospitalization or make a copy of clinical notes.
4) Enclose release of information and clinical notes in a sealed envelope and provide to the ambulance driver to deliver to the admitting professional.
5) Tell the ambulance driver in front of the student that the student is a danger to him/herself or someone else and should be escorted to the admitting professional. The ambulance driver should be told to call the Counselor/Psychologist if the student does not complete the admittance procedure.
6) If the student is not admitted but you continue to feel hospitalization is necessary, you should call ACCESS (961-8400) for help getting an ECO (Emergency Custody Order) in order for the police to pick up the student and for ACCESS to evaluate the student for an involuntary hospitalization or voluntary admission to a state hospital. Make sure the student understands that you will do this before the student leaves for the hospital.
Complete all paperwork documenting this process. At any point in this process, Counselors/Psychologists should consult with other staff members, as needed