Appalachian State University Counseling & Psychological Services Center

Policies & Procedures

August, 2004

TABLE OF CONTENTS Eligibility for Services.............................................................................................. Summer Session ........................................................................................... Minors ........................................................................................................... Spouses and Family......................................................................................

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Intake and Scheduling Procedures......................................................................... Walk-In Clinic.............................................................................................. Assigning Clients.......................................................................................... Scheduling On-going Clients....................................................................... Treatment Guidelines .................................................................................. No Show Policy……………………………………………………………. Follow-up from Walk-Ins............................................................................

2 2 3 4 4 5 5

Clinical Documentation-Protégé and Paperwork ................................................. Dealing with Old Client Files ...................................................................... Creating Files for Potential Clients ............................................................ Clinical Note Content—PIP System........................................................... File Storage ................................................................................................... Release of Information ................................................................................ Evaluations of Clinical Services..................................................................

5 7 8 8 9 9 10

Clinical Services: Limits and Review..................................................................... Individual Therapy and Peer Review Process........................................... Changing Counselors................................................................................... Group Therapy............................................................................................. Group Referrals ................................................................................. Co-leaders/Interns ............................................................................. Group Notes ....................................................................................... Psychiatric Consultation ............................................................................. Court Referrals ............................................................................................ Clients with Attention Deficit Disorder ..................................................... Campus Health Service ............................................................................... Testing........................................................................................................... Student Wellness Center ............................................................................. Peer Outreach Programs................................................................... Biofeedback........................................................................................ Substance Abuse................................................................................. Peer Career................................................................................................... Individual Counseling List.......................................................................... Single Sessions During Final Week ............................................................

10 10 10 11 11 12 12 12 14 14 15 15 16 16 16 17 17 17 18

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Emergency Procedures: At-Risk Clients ............................................................... On-Call/Emergency Procedures ................................................................. Emergency Meetings with Clients in Crisis............................................... Counseling Center ............................................................................. The Infirmary ..................................................................................... Watauga Medical Center Emergency Room...................................... University Police................................................................................ Volatile Clients ............................................................................................. Suicide Attempts/Gestures-Notification of Parents .................................. Sexual Assault............................................................................................... Hospitalization.............................................................................................. Psychological Withdrawals ......................................................................... Situations Requiring Notification of the Director/Assoc. Director .........

19 19 21 21 21 21 22 22 22 23 23 24 25

Common Ethical Concerns ..................................................................................... Dual Relationships ....................................................................................... Therapist-Trainee Clients ...........................................................................

25 25 26

Outreach and Consultation..................................................................................... Processing Requests ..................................................................................... Bulletin Boards............................................................................................. Residence Life Consultants ......................................................................... Uncle Sigmund ............................................................................................. Uncle Sigmund Advisor...................................................................... Guidelines for Uncle Sigmund Responses ......................................... Accessing Uncle Sigmund ..................................................................

26 26 27 27 27 28 28 29

Staff Expectations .................................................................................................... Schedules....................................................................................................... Leave ............................................................................................................ Adjunct Staff ................................................................................................ Private Practice ............................................................................................ Position Responsibilities .............................................................................. Professional Development ........................................................................... Teaching........................................................................................................ Licensing ....................................................................................................... Supervision ................................................................................................... Administrative Support............................................................................... Front Desk .................................................................................................... Meetings ........................................................................................................ Staff Meeting ...................................................................................... Peer Supervision ................................................................................ Psychiatric Consultation.................................................................... Committees ................................................................................................... Annual Performance Review ......................................................................

29 30 30 30 31 31 32 32 32 33 33 33 33 33 34 35 35 35

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Training ............................................................................................................ Practicum...................................................................................................... Master’s Level Externship .......................................................................... Pre-doctoral Internship ...............................................................................

35 35 36 36

APPENDICES .......................................................................................................... Appendix A: Mission Statement ................................................................. Appendix B: Severity Rating Descriptors.................................................. Appendix C: WIC Procedures Checklist.................................................. Appendix D: Treatment Guidelines ........................................................... Appendix E: Walk-In Flow Chart.............................................................. Appendix F: Policy on Release of Counseling Center Records ............... Appendix G: Individual Counseling Feedback ......................................... Appendix H: Session Extension Request Form for Peer Review ............ Appendix I: Psychiatric Referral Criteria................................................. Request for Consultation for Counseling Center Client .............. Appendix J: Authorization to Release Information …………………… Appendix K: Single Assessment Report .................................................... Appendix L: Career “Prescription”........................................................... Appendix M: Individual Counseling Information .................................... Appendix N: Counseling Center Emergency Services ............................. Appendix O: Volatile Clients-Safety Procedures...................................... Appendix P: University Policy on Suicidal/Dangerous Behavior............ Appendix Q: Sexual Assault Protocol ........................................................ Appendix R: Involuntary Commitment Guidelines ................................. Appendix S: Psychological Withdrawal Handout .................................... Appendix T: Psychological Withdrawal: Memo to Treating Professional Appendix U: APA Code of Ethics............................................................... Appendix V: Leave Request Form ………………………………………. Appendix W: Position Descriptions—Responsibilities and Activities .... Appendix X: Annual Performance Review ...............................................

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CLINICAL POLICIES AND PROCEDURES This document represents the current guidelines for clinical policies and procedures adhered to at the ASU Counseling and Psychological Services Center. Of course, there will always be the need to make exceptions in deference to sound clinical judgment. The general expectation is that staff will seek consultation, most often through peer review, before making decisions that deviate from these guidelines. Eligibility for Services The Counseling and Psychological Services Center offers services to students who are currently enrolled in courses at ASU. See the Counseling Center’s Mission Statement (Appendix A). Any exceptions should be implemented only after the case has been discussed in a peer review. On occasion, during an emergency, the decision may need to be made to see a nonstudent for crisis intervention. Consultation with the Director, Clinical Director or through peer review is important, and the decision should be reviewed by the staff at the next available opportunity for peer review. Summer Session Students who are enrolled for at least one of the summer sessions may be seen at any point throughout the summer. Sometimes, sound clinical practice dictates that non-enrolled students are allowed to continue in therapy during the summer. Such exceptions should be discussed in peer review, taking into consideration continuity of care issues and necessity of remaining with their current counselor at the time, if the student plans to be enrolled in the fall, prior use of and benefit from services, etc. Minors Legally in the state of North Carolina, minors cannot be seen for ongoing treatment without the consent of their legal guardians, except for substance abuse treatment. In emergency situations, it may be necessary to provide crisis intervention, but on-going services cannot be offered before consent is obtained. Clinicians planning to refer minors for individual counseling should explain this policy to clients so that they can obtain consent from their legal guardians and provide such consent to the Counseling Center.

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Spouses and Family Staff and faculty and their families (who are not students) are not eligible for services at the Counseling Center. They should be referred to the Faculty and Staff Counseling Services located in the Hubbard Center for Faculty and Staff Development. Non-student spouses, partners, and/or family members may be seen conjointly with the student if clinical judgment indicates that their involvement would be important in order to best address the student' s concerns. Intake and Scheduling Procedures Walk-In Clinic The Walk-In Clinic (WIC) functions as the intake process for new clients and also provides the structure for responding to student crises during the day. Students are seen on a first-come, first-served basis during WIC hours (typically 1:00 - 4:30 p.m. Monday – Thursday; 1:00 – 3:30 p.m. on Friday). The schedule of WIC coverage for which each staff is responsible is set at the beginning of each semester. If a counselor is planning to be out of town, s/he is responsible for ensuring that the staff is notified ahead of time to arrange for adequate coverage for their WIC hours. Students are given a one-page description of the Walk-In system while they are in the waiting room. Some read it well; some don' t, or remember little of it. It is good practice to summarize the procedure, especially the limit of 20 - 30 minutes, the nature of confidentiality, that it is not meant to be therapy per se, and that they will, given scheduling constraints, probably be working with a therapist other than the WIC counselor should they decide to pursue counseling. It is good to be mindful of the possibility that an intake session, especially if it can be a full hour, may be all that is necessary and that a recommendation of no current need for therapy may at times be the recommendation of choice. The front desk staff will call the WIC counselor' s office 20 minutes into the session if there is another client waiting to be seen. This permits some flexibility to take additional time for complicated cases or crises (if nobody is waiting), though it cannot be guaranteed. Often, this extra time will not be possible, and the counselor will need to schedule the client for an extended assessment session. This extended session should be with the original WIC clinician, except in cases where quick intervention is vital and the WIC clinician has no openings in his/her schedule. If the counselor judges the WIC client to be an emergency, then they take priority, and

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anybody who is waiting should be informed of such and given the opportunity to either continue waiting or return at another time. The WIC system has proven to be an efficient form of intake for the Center, yet it is quite challenging for counselors. Twenty to thirty minutes is an extremely short time to conduct an assessment and to establish rapport, keeping in mind that this may be a first visit to a mental health agency for many, and an experience that may entail some amount of anxiety and fear. Each counselor aims toward achieving some balance of assessment and rapport based on individual styles and implicit values about therapy. It is important to be mindful of not focusing on either the assessment or the therapeutic aspect of this initial session to the extent that the other is not sufficiently addressed. A written WIC assessment should be completed as soon as possible after the walk-in appointment. A severity rating should also be given (See Appendix B). Outcome Questionnaires and Wellness Checklists, completed with the other intake paperwork, should be pulled from the file and placed in the box at the front desk (marked OQs to be scored) so that they may be scored and entered into the database. Sometimes clinical necessity demands that counselors wait until their WIC time is over to write up notes from the WIC sessions; other times it will be possible to take a few minutes in between WIC clients to complete the WIC form. The goal is to maintain a balance between accurate and timely documentation and prompt service to clients who may be in crisis or coming to speak with a Center counselor for the first time. It is especially important to be mindful of timely completion of these WIC notes since the Case Disposition Team reviews them every Wednesday and Friday and uses the information to assign clients to therapists. Appendix C contains a checklist of the procedures that need to be completed upon completion of a WIC assessment. Assigning Clients Clients will be assigned to counselors based on the WIC assessment; this mostly involves the determination of whether a client needs to see a full-time senior staff, part time staff, or one of the various levels of trainees who may be working at the Center in any given semester. Clients will be matched with therapists through the Case Disposition Team (Clinical Director, Training Director, and Master’s-Level Training Coordinator). Following a WIC intake session in which the therapist recommends individual counseling, the WIC Assessment should be written, a copy of the WIC assessment should be printed for the hard copy file and the file placed

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in the Case Disposition box in the vault. Every Wednesday and Friday morning, the Case Disposition Team will meet to review files of all clients taken into the Center since the last team meeting. Clients will be assigned to therapists of the appropriate level with caseload openings. It is therapists’ responsibility to make sure their electronic schedules are kept up-to-date with openings and that WIC assessments are completed promptly so that minimal delay occurs between the WIC and assignment to an ongoing therapist. Clients are not to be scheduled appointments to see counselors without going through the WIC system, unless they have already been a client at the Center. If this is the case, then their previous counselor, if available, should make the determination if the client is to be scheduled directly with a counselor or have a WIC session. It cannot be guaranteed that a client will be able to see a specific counselor. This decision will depend on the counselor' s schedule and the reason for the request; if either of these is questionable, the requested counselor should be consulted. Students should be reminded of these limitations; an attempt will be made to honor requests to work with a particular counselor, but they may need to be prepared to wait longer to be accommodated. Scheduling On-going Clients Counselors are responsible for completing their electronic schedules and keeping them upto-date throughout the semester. It is especially important that counselors indicate their available clinical times (with “open” in a client time) other meeting times, and any other pre-arranged commitments at the beginning of the semester. With the introduction of the electronic scheduling system in Protégé, counselors should schedule ongoing client appointments from their office. The front desk staff may use open therapy appointment times so indicated on the electronic calendar to schedule ongoing clients who may phone for an appointment. Therefore, it is critical that counselors ensure that appointments and available times are kept up-to-date and accurate on the electronic schedule. If counselors get double booked, it is the counselor’s responsibility to clarify who is to be seen and who is to be rescheduled, and make sure that the client is notified. Treatment Guidelines Generally, clients who are unlikely to benefit from time-limited therapy, or who require more intensive monitoring than can reasonably be offered by the Center, should be considered for outside referral (see Appendix D for a complete list of criteria). Frequently, students’ lack of

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financial resources is a determining factor. Counselors should use their best clinical judgment and seek peer consultation as needed when determining whether to refer, where to refer, and how much follow-up, if any, is called for on the part of the counselor to ensure that some intervention has taken place with a client. A list of local referral options, which can be given to clients, is available at the front desk. No Show Policy The Center has adopted a “No Show Policy”. Clients are informed that if they do not keep a scheduled individual therapy appointment and do not call to reschedule within 48 hours after the appointment, their file will be closed and the center’s services to them will be considered completed. If clients subsequently wish to reconnect with their counselor, see a different counselor, or request another Center service, they should contact either their original counselor or return to the Walk-In Clinic. Clinical judgment should dictate when exceptions should be made to the No Show Policy, as in situations where a particular client may need personal followup. Follow-up from Walk-ins The Walk-In flow chart, Appendix E, illustrates the procedure to follow if a client referred to a therapist from WIC does not show for the first appointment. The counselor should notify the person who conducted the walk-in of either a no-show or cancellation without rescheduling. The WIC counselor then decides whether to allow the no-show policy to take effect, or on some type of follow-up contact with the client, either letter or phone call, particularly if the client' s issues require that an effort be made to facilitate prompt intervention (i.e., danger to self or others, or acute decompensation). Clinical Documentation—Protégé & Paperwork Please see the Protégé Database Manual for specifics on working with Protégé. The Center’s long-term goal is to be relatively “paperless” with regard to client files. However, for the time being, certain hard copy documentation will need to be kept in client files. Please keep in mind that as the Center transitions to the use of Protégé, some of these guidelines may need to be modified.

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1. The Center will continue to assign client numbers to new clients and to create a file for any new client who has contact with the Center. 2. The initial paperwork clients complete when they make their initial contact with the Center will still be kept in these files. 3. The WIC Assessment counselors complete in the database should be printed and placed in the client’s file for review by the Case Disposition Team. 4. Signed taping permission forms, authorizations for release of information, testing protocols, answer sheets, etc., and any documentation about clients received from outside agencies will also be kept in the hard copy file. 5. When a client is referred to the psychiatrist or the dietician, a copy of the referral completed in the database should be printed out and placed in the client’s file. 6. When a client’s file is closed and the Closing Summary is completed in the database, the Closing Summary should be printed (on pink paper) and placed in the client’s hard copy file. The Closing Summary should be the first document in the hard copy file for ease of reference in emergency situations. 7. Until further notice, all weekly progress notes should be created in Protégé, then printed and placed in the paper file. When counselors are closing cases, they should review the file to double-check that all notes have been accurately completed. Any missing or unfinished documentation must be completed before the file is closed. Completed files should include the following documentation: --Demographic Information completed by clients at initial appointment -- WIC Assessment Report -- Progress Notes -- Treatment Plan (optional) -- Case Closing Form (completed on any client who received services past a WIC session) -- Permission to tape form (if applicable) Case notes should be completed the same day, if possible, or at least the day after a session. All notes are now dated and signed electronically. If the clinician is a trainee, the supervisor

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electronically signs all completed notes as well. At closing, all clients should have a diagnosis (even if V71.09 – no diagnosis or 799.9 – diagnosis deferred) and coded therapy issues. Requests for release or review of records are treated in accordance with the APA ethical guidelines. Records are released only to licensed mental health professionals. If a client asks to review a file, an attempt is made to ascertain not only the motivation behind the request, but the potential impact on the client’s welfare. If there is a questionable judgement to be made, the client should be notified that a decision will not be made until there is a chance for peer review, as it is not standard policy for anyone but the clinician to view/use those files. If the client still insists, files are to be reviewed with the clinician in their office. Dealing with Old Client Files Upon occasion a clinician may come across a file for a client returning to the Center for whom the previous contact with the client was not properly closed or organized. The following guidelines should be used for organizing such hard copy files: •

All stapled from most recent to most dated, with pink closing form on top after the file is closed (while open, Progress notes will be on top); THEN,

•

Progress notes, which includes any consultation contacts about client – individual and psychiatric notes in one layer, with psychiatric notes behind the individual notes; group, biofeedback, nutritionist, and any other type of contact that is distinct (like perhaps Eating Concerns Treatment Team) is to have its own layer of progress notes; DO NOT write a note for one modality of service on pages of notes for another modality of service – keep the modalities distinguished; each modality of service (i.e., individual (psychiatric services subsumed under individual), group, biofeedback, nutritionist, etc.) gets their own pink closing form upon closing that particular contact of the file; THEN,

•

WIC form (either hand-written or from the database); THEN,

•

Intake forms –, service agreement, gold sheet, wellness self-check; THEN,

•

Miscellaneous forms like taping form, session rating form, records that may have been sent about that client, release of information form, request for consultation form, session extension request form, letters sent to client or on behalf of client, treatment plans, etc.; the order of these miscellaneous forms does not matter, as long as they are part of the same layer; THEN,

•

Testing forms, like MMPI-2, BDI-II, MCMI-III, MBTI, Edwards Personal Preference, MSEI, EDI-2, 16-PF, ISB, WAIS-III, TAT, Rorschach, etc. (including protocols, answer sheets, etc.); the test write-up is to be on top; THEN,

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•

OQ forms – however many the client did while in treatment, sorted and organized in the file by individual, group, biofeedback, nutritionist, etc.; again, from most recent to most dated; THIS SHOULD BE THE LAST PAGE(S) OF THE NOW LAYERED BUNDLE

Creating Files for Potential Clients A client file (both hard copy and in the database) should be created for any student about whom any clinically significant information is received, either through direct contact or consultation. The front desk staff can help with this. This will ensure that any critical information is available, should the student decide to come to the Center for services or become involved in an after-hours emergency. This also establishes a client number to record the activity for future contacts. When a student who is not already a client is seen on an emergency outside of the center, it is helpful to get identifying information. A completed Personal Data Form (Gold Sheet) would be preferable, if possible, though often it will not be. At least, an attempt should be made to obtain a name, phone number and a close relative or friend to contact should their situation worsen. Clinical Note Content – PIP system Notes should include the following info, though this may be in the clinicians’ own order and style. This is not meant to constrain, but to facilitate a baseline of clinical quality in our documentation. a) Presentation – Some assessment of how client is doing, functioning, where at in terms of therapeutic focus. b) Issues – Some notion of how addressed, gives indication of what was done in therapy. Things like “worked on x,” or “affect was appropriate” are not sufficient, as they give no meaningful information if another clinician were to read the file, and wanted some guidance on how to start dealing with the client, which a note should do. c) Plan – some indication of the focus being pursued, some continuity to therapy, or rationale for adjustment. This might include things like homework, idea of what therapy might focus on at the beginning of the next session, worsening or bettering prognosis, plans for shorter/longer length of therapy than agreed upon, etc.

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File Storage Hard copy versions of client files are kept in the filing cabinet in the vault area behind the front desk area. Front desk staff will pull hard copies of old client files at WIC and, until further notice, will continue to pull all files of clients to be seen each day. Trainees (who are ASU students) may not enter the file cabinets to retrieve their own files so that the confidentiality of fellow students who may be clients at the Center is not compromised. Trainees should ask a front desk staff person or clinician to pull hard copies of files they may need. All hard copies of client files must be returned to the storage room by the end of the day, as it is the only room in the Center that is kept consistently locked and inaccessible to non-clinicians over night. If case notes or other documentation is not completed by the end of the day, the file must still be returned for secure storage and retrieved the next day. It is also important that all files be available in case the on-call counselor must respond to an after-hours emergency with a client of the Center and needs a file for information or documentation. Release of Information Confidential information may not be released or discussed with anyone other than Center staff without a signed release of information form in the file of the client involved (except as required by law). (See Appendix F for the Center’s Statement of Policy.) The Authorization for Release of Information form must be signed and dated by the client, and signed by a witness other than the counselor named in the release for the form to be valid. A signed release must be obtained whenever confidential information is to be shared with a person or agency outside the Counseling Center, including the infirmary (for which there is a separate release), Residence Life staff, or other University staff and faculty. Note: Residence Life staff and other campus offices have their own guidelines for the reporting of critical information and incidents, and are often accustomed to freer sharing of information in their work environment than is allowable for counselors. They may need to be reminded from time to time that therapists are ethically and legally bound to much tighter constraints in this regard, and do not have the prerogative to share some types of information which other campus staff might ordinarily expect to exchange.

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Evaluations of Clinical Services Each counselor is responsible for their clients being giving an evaluation form (see Appendix G), either in person or via mail, after the 4th session and/or prior to or upon termination of services at the Center (currently, the OQ-45 is completed as well). It has historically been difficult to have evaluations at the Center given, completed and returned with consistency. Therefore, it is critical that clinicians attend to session numbers when completing documentation of client sessions. When a clinician schedules a 5th or termination session for a client, the clinician should put (EVOQ-Session #-Client #) next to the client’s name in the schedule. The front office staff will give the client an evaluation (and OQ) to complete upon arriving for their next session. Clinical Services: Limits and Review Individual Therapy & Peer Review Process Center therapists are expected to work within a time-limited framework—10 individual sessions. The goal of time-limited counseling in a university counseling center is to reduce the amount of time clients must wait to see a counselor, to facilitate a timely return to adequate functioning, and to refer as many long-term issues to other outside resources as possible. Refer back to the Treatment Guidelines. For many students, outside referral is made difficult because of financial constraints; these cases should be discussed in peer review. When a client has received six or seven sessions, and it is anticipated that he/she will continue for more than a couple of additional sessions beyond the 10 session limit, the therapist should present the case for peer review, usually in the peer supervision meeting (See Appendix H for the Session Extension Request Form for Peer Review). The case can then be considered with respect to Center-wide needs and current clinical demands and potential fit for other resources, i.e., participation in one of the Center’s groups. Changing Counselors Clients are discouraged from changing therapists. Clients who make this request should be encouraged to talk with the original therapist to clarify any confusion and provide feedback prior to making a switch. An appointment should be made with the original therapist unless the client objects. If a client refuses to speak with his/her original therapist, he/she will be directed to come in during WIC hours to discuss this issue with another therapist. Generally, if a client

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insists on a change, the request will be granted if it is the first such request, but this is ultimately a matter of the clinical judgment of the therapists involved. If there have been multiple requests, underlying clinical issues will likely need to be addressed before the request is granted. Group Therapy There is no limit to the number of group therapy sessions offered to clients as long as they are appropriate for group treatment. Counselors are encouraged to consider referral to the Center' s groups when doing walk-ins, especially for clients who have had previous therapy experience. Therapy groups should be considered a primary option when a counselor has worked long enough with a client on an individual basis that the client would be able to participate in and benefit from a group. General Therapy groups (entitled "Understanding Self & Others") are the main groups offered at the Center. It has been found that this facilitates the group referral and preparation process and has enhanced overall utilization of group therapy at the Center. However, some specific theme groups are still offered for populations that generally might not otherwise be attracted to heterogeneous groups, such as eating disorders, ADHD, and gay/lesbian/bi-sexual groups. Other groups have been offered, and will be considered as well, while maintaining care not to disrupt the general group therapy orientation of the Center. Group schedules are worked out 2 - 3 weeks prior to the end of the semester in order to facilitate group referrals and timely starting points for the next semester' s groups. Group Referrals Group leaders should indicate in the Comments section of the group list in Protégé whether they wish to do a screening interview and the length of the interview (usually one half-hour), which permits clients to be scheduled immediately for screening interviews. The WIC therapist should assign clients referred to group from WIC to the appropriate group. Therapists referring individual clients to group should make certain the client is assigned to the group. The names of properly assigned clients will then appear on the group list in Protégé. The group leader should mark the group closed when no more referrals will be accepted. Ultimately, this process is meant to facilitate efficient forming of viable groups, which is always a concern at the start of each semester.

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Co-leaders/Interns Interns often co-lead groups with senior staff. The Center' s policy is that trainees do not lead group sessions alone unless the counselor and intern have already agreed that s/he is ready and willing to facilitate a group session independently. If this is not the case and the senior staff leader must be absent, the session for that week must be cancelled. Group Notes Client notes are kept in clients'individual files. Files of group members who stop coming to group should be closed and the client sent an evaluation as soon as it becomes clear that they are not returning. Case Closing forms must be completed for each ongoing group client, printed and placed in the client’s hard copy file. Group evaluation forms (yellow), as well as OQ’s are to be given to all group members at the termination of the group (it is probably easiest to do this on the 2nd to last session). Psychiatric Consultation Appendix I, Psychiatric Consultation Criteria, provides guidelines for making the determination of whether or not a client is appropriate to refer to the Center' s psychiatric consultant. It is important to be cognizant of the limitations of this service, and to convey that expectation to the client from the first referral. The purpose of the consultation model is to provide sufficient psychiatric contact to assess for the potential usefulness of medication and ensure medical stabilization if medication is prescribed. Since psychiatric coverage is limited, ongoing psychiatric services cannot be offered, as this would eventually result in the restriction of access to psychiatric appointments to only a small segment of the Center' s clientele. The general expectation is that clients can be referred to other local resources for monitoring/followup after three or four M.D. sessions. Psychiatric services are offered to ongoing clients only, i.e. those who have attended at least 3 therapy sessions. This serves to allow for fuller assessment of clinical issues, as well as to limit psychiatric services for those whose primary motivation is to work in therapy. Students who present primarily seeking medication should be referred elsewhere. Exceptions may be made in consultation with other staff, depending on the current psychiatric load and the severity of the client’s concerns. Likewise, those who terminate counseling at the Center must find medication services elsewhere.

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Clients should be given a gold Psychiatric Consultation appointment form (kept at the front desk) when they are scheduled for the psychiatrist. This form serves as a reminder of the scheduled time, as a statement regarding the Center’s policies on no shows and cancellations for psychiatric appointments, and is another prompt to set the expectation that psychiatric consultation service at the Center will involve only 3-4 sessions. Please note the following policies regarding cancellations and no shows of psychiatric appointments: Appointments must be cancelled by the Wednesday prior to the scheduled appointment. Failure to cancel by Wednesday at 5 pm, or not keeping a scheduled appointment, will result in the client’s appointment being listed as a “no show”. The front desk will not schedule appointments for clients who have no showed for psychiatric consultation appointments. Any student who no shows for an appointment with the psychiatrist will need to speak with his/her clinician before being allowed to schedule another appointment. Clinicians should exercise care in determining whether or not these clients should be re-scheduled or referred into the community. Clients who no show for 2 appointments with the psychiatrist should be provided a referral into the community for psychiatric services. Requests for exceptions based on clinician judgment and/or demonstrated financial need should be discussed with the Clinical Director. Any student who cancels 2 consecutive appointments should also be provided a referral into the community for psychiatric services. Requests for exceptions based on clinician judgment and/or demonstrated financial need should be discussed with the Clinical Director. To make a referral to the psychiatrist, a Psychiatric Referral (also in Appendix I) is to be completed in the database, including any information necessary for the psychiatrist to address the referral question. This form should then be printed out and placed in the client’s file so as to be available to the psychiatrist. A release of information should be completed for any clients for whom information may need to be shared with the Health Services, such as medical tests for certain medications (e.g. lithium) or issues requiring medical monitoring (e.g. severe eating disorders). It is also sound clinical practice to be able to consult with any practitioners who may have rendered prior medical/psychiatric consultation. Practicum students and interns must obtain the approval of their supervisor prior to scheduling any clients to see the psychiatrist.

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Psychiatric consultation is the most expensive service offered by the Center; so missed appointments are quite costly, in addition to tying up times that might be utilized by others, thus the policies about no shows and cancellations. In an effort to avoid paying the psychiatrist for time he/she is in the Center without appointments, we have established a waiting list for psychiatric appointments. If you have a client in need of psychiatric consultation and there is a clinically significant delay before the first available appointment time, you may schedule your client for that appointment, and also create a “waiting list” for the psychiatrist’s schedule for his/her next day in the Center. On the psychiatrist’s next day at the Center, type “Waiting List”, then list your client’s name, your name, your client’s phone number and the date/time of the scheduled appointment. As the front desk is notified of cancellations, they will contact individuals on the wait list to see if they can fill in on cancelled appointment times. The front desk also will continue to place reminder calls to clients regarding their upcoming psychiatric consultation appointments. Psychiatric sessions are generally scheduled for one half hour, but may be made for a full hour for complex cases, though this may not always be an option, depending on the psychiatrist’s schedule for a given day and overall caseload demands. The therapist’s name should be placed next to the appointment on the psychiatrist’s schedule for ease of making decisions on potential follow-up for clients who no-show for M.D. appointments. Counselors are responsible for monitoring their clients who meet with the psychiatrist in terms of significant medication concerns that arise, as well as number of M.D. visits, again, with the aim of facilitating referral for outside psychiatric monitoring after three or four M.D. visits or so. A weekly, half-hour consultation meeting with the psychiatrist provides the staff the opportunity to discuss medication concerns or the appropriateness of outside referral, taking into consideration the current psychiatric caseload and level of demand. Court Referrals The Center does not promise to provide a specified number of sessions for court-mandated treatment. If the mandated treatment fits within our time-limited model, treatment may be provided at clinician’s discretion. Clients with Attention Deficit Disorder The Center does not provide assessment for ADHD or Learning Disabilities. Clients requesting such assessments can be given a list of referrals for this purpose. They are not to be

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referred to the Center' s psychiatrist as this would quickly overload the Center' s limited psychiatric services and preclude the use of psychiatric consultation to address other, more immediate concerns. If a client can provide documentation that a valid assessment has been done and a diagnosis of ADHD established, they may be referred directly to one of the University Health Service physicians. If medication has been recommended and the physician is given such documentation of the assessment, along with a note from a Center counselor, they may prescribe medication if appropriate and monitor for side effects, dosage changes, etc. Campus Health Service It is good practice to write a short note or make phone contact with the infirmary physicians to explain the purpose of the visit when a student is referred to them. The Health Services Referral form (Appendix J) can be used for this purpose. It is a common for clients to tell a medical doctor something different than what they told their counselor when the referral was made, and sending a referral form can reduce any confusion that might otherwise exist. Usually it is best to schedule an appointment directly with one of the doctors if possible, as this will decrease the amount of time and frustration that may be experienced by students in duress at having to go through another intake process. Also, if emergency clients are seen in the infirmary, or stay there at the request of a counselor for emergency monitoring, a note should be left in the client’s medical chart, including instructions about who is to be contacted should complications arise. Testing To arrange for a client to take a test, schedule a time in the Protégé calendar under “Testing Room”. On the calendar indicate the client’s name, the test and the counselor’s name. For tests that require computer administration (MMPI, MCMI, CISS), clinicians will need to check with the front desk to make sure that the computer will be available. For the MMPI-2 and the MCMI it is a good idea to schedule 2 hours for the test to be completed. For the CISS, one and one-half hours are usually sufficient. When a client comes to the Center for a test, the front desk will check the calendar and administer the test. The test results will then be placed in the counselor’s mailbox. The Testing Notebook, located in the vault, will have a listing of available tests as well as descriptions and sample reports. Questions about available psychological tests should be directed to the Center’s Assessment Coordinator. Any test administered to a client must have a

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psychological evaluation summary in the client’s file in the database (see Appendix K; template also available in Protégé). Clients for whom interns administer an integrated test battery should have the comprehensive report in the client’s hard copy file, rather than the summary evaluation in the database. Student Wellness Center The Student Wellness Center seeks to assist individuals in adopting healthy lifelong habits to achieve an optimum state of wellness. Because of the wealth of resources available on campus, programs are often coordinated with other departments. The Student Wellness Center offers workshops and individual counseling on stress, time management, nutrition, weight management, alcohol and drugs, and smoking cessation. To refer a student for any of the Wellness Center services or activities, call upstairs to the front desk of the Wellness Center and the staff will assist you in scheduling an appointment with the appropriate clinician. If you have special concerns or thoughts, leave a note for Kit Olson or Dale Kirkley. Peer Outreach Programs The Wellness Peer Educators are student volunteers whose mission is to teach other students about health and wellness. Wellness Peer Educators present wellness programs in residence halls as well as to student clubs and organizations. Wellness Peer Educators emphasize information given in exciting and fun ways and involve participants in looking at their own lifestyles. Programs encompass all six dimensions of wellness—social, occupational, spiritual, physical, intellectual, and emotional. Students are now able to take a class in conjunction with their work as a Peer Educator, thereby receiving course credit. Biofeedback Biofeedback is available to treat anxiety and stress-related physiological disorders. Biofeedback therapy monitors physiological changes (muscle tension, skin temperature, electrodermal response) that take place in response to anxiety or stress. Using biofeedback and relaxation training, the client learns to identify and change thoughts and feelings that produce physiological symptoms of stress. Biofeedback is helpful in treating the following conditions, among others: anxiety; agoraphobia; panic attacks; high blood pressure; muscle tension; tension headaches; Raynaud’s

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disease; migraine headaches; colitis; dermatitis; ulcers; insomnia; esophageal reflux; irritable bowel syndrome; chronic pain; and temporomandibular joint syndrome (TMJ). Biofeedback therapy includes an assessment, and typically about four one-hour therapy sessions. Approval of a physician may be required. Home practice of relaxation techniques is generally expected. The client may also be asked to make lifestyle changes, such as increasing exercise, smoking cessation, reducing caffeine intake, or improving nutrition. Substance Abuse The Alcohol and Drug Assistance Program offers individual consultation and counseling to students regarding issues related to substance use and abuse. Confidential assessment and counseling is available, as well as individual support or treatment. Group support is also available to students seeking lifestyle changes or recovery support. Peer Career Clients who can benefit from paraprofessional career counseling that emphasizes selfassessment, career information, and decision-making should be referred to the Peer Career Center for services. Students who are unable to benefit from paraprofessional career counseling, or whose career issues are complicated by significant personal issues or maladjustment, should receive their career counseling from Counseling Center staff. When Peer Career resources are requested for these clients, they should be referred to Peer Career and given a "Career Prescription" sheet (Appendix L), which provides instructions to the paraprofessionals and notifies them that another counselor will process the results of any assessments done in Peer Career. Individual Counseling List (formerly known as the Waiting List) When clinical appointment times are full, the Individual Counseling List used for Case Disposition also serves as the waiting list. The procedure for assigning clients to counselors remains the same (see “Assigning Clients”), except that there will be a slightly longer delay for clients to be assigned to therapists. It is important that therapists keep their client openings upto-date in their schedules so that client assignments can be expedited. Clients, who remain “unassigned” after WIC, are automatically displayed on the Individual Counseling List in Protégé. The information necessary for assignment to a therapist is

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automatically copied from the client’s electronic file. If you see a client on intake who requires quick intervention and for whom an outside referral cannot be found or is not appropriate, you should inform the Clinical Director of the need for special accommodation for the client. When clients are referred for individual counseling, they should be given the individual counseling information sheet (copies are in the case disposition file at the front desk; also, see Appendix M) which explains the contact procedure and encourages them to inform the Center if they decide that they no longer wish to be considered for clinical services at the present time. As the semester progresses and if there arises a delay in being assigned for services, clients should be offered the option of referrals for therapy outside the Center. When clients request to see a particular counselor, it may be wise to challenge this request if there are other counselors available. If they still insist on a specific counselor, they should be informed that it would likely involve a longer delay. The Clinical Director is responsible for consulting with that counselor about their potential availability, and planning accordingly in consideration of the level of need and priorities of clients already on the Individual Counseling List. The Director of Clinical Services is responsible for monitoring the Individual Counseling List. If a counselor puts a client on the list who requires attention as soon as possible (i.e. suicidal clients, victims of recent trauma, becoming unable to function, etc.), the Clinical Director should be alerted so that scheduling priorities can be adjusted. Clients should be informed if they are unlikely to be seen within a couple of weeks or by the end of that semester. Outside referrals and alternative resources should also be given. Again, severity ratings (based on the DSM GAF) should remain as consistent as possible (see appendix B), and are not to be used as a red flag for clients in need of immediate intervention. Rather, a note can be left on the WIC assessment, or consultation sought with the Clinical Director. Single Sessions During Finals Week It has been the practice at the Center to terminate with on-going clients the last week of classes in order to be available for single sessions during finals week for clients who were not able to see a counselor before the end of the semester. This decision is made by the staff on a semester-by-semester basis, depending on the status of the waiting list as well as counselors' current caseloads. Before assigning clients for a single session, it is important to assess clients' presenting issues and whether or not they plan to continue therapy sessions in the next semester

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in order to determine whether a single session may be of clinical value in each case. It is assumed that counselors’ clinical times will remain the same during finals week, unless they notify the front desk, or mark the master schedule differently. Emergency Procedures: At-Risk Clients On-Call/Emergency Procedures “Emergency” is defined to Residence life staff and the university community as is seen in Appendix N. Daytime emergencies are handled by any available senior staff. Other Center activities such as meetings, supervision, and even client appointments take second priority. If obligations must be cancelled, it is usually resolved through informal discussion amongst the staff as to which counselor would be caused the least disruption by attending to the emergency. Senior staff and pre-doctoral interns are responsible for being the primary on-call person approximately five or six times each semester according to the on-call rotation established at the beginning of each semester. The Director of Clinical Services finalizes the On-Call Schedule at the beginning of each semester, with consideration given to staff' s individual obligations and preferences for specific time periods to the extent possible. On-call coverage alternates between 2 shifts each week—Monday - Thursday, and Friday - Sunday rotations. Scheduling conflicts inevitably arise at some point during the course of a semester; the staff on call is responsible for arranging alternate coverage (usually meaning trading shifts with another staff). Senior staff members also rotate to be available for consultation when the pre-doctoral interns are on call. They should carry a beeper for these rotations, and/or the cellular phone, and clarify arrangements for contacting them, i.e. whether the intern will call them after initial contact with the campus police or initial contact with the client, and if this is to be via the cellphone, pager or at home. Copies of each semester' s on-call schedule are given to Campus Police, the Infirmary, the Watauga Medical Center Emergency Department, and New River Behavioral Healthcare with the number to activate the beeper. They are given instructions to call the beeper # first, and use home telephone numbers only if the beeper fails. However, this is not always followed consistently, so it is wise to inform Campus Security and the Infirmary if exchanges are made for on-call coverage that are different than what was originally written on the schedule. The counselor on-call is required to carry the pager and to remain within pager range of the

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University during that rotation. This usually works as far as Blowing Rock & Banner Elk, but there have at times been some inconsistency with the pager functioning, so if there is uncertainty about the pager functioning from a specific location, call Campus Police to test it. There is a cellular phone available for the on-call person, which allows on-call staff some freedom for activities in areas where there is not immediate access to a phone (such as hiking). This phone can also be called in areas outside of beeper range. If it is to be used, Campus Police should be given the number of the cellular phone, and instructed to use that number in case of an emergency. As this phone is rather expensive to use, it should be used only for minimal contact and another phone located for more extensive consultation if needed. Confidential information should be avoided, if at all possible, when using the cellular phone. Counselors only respond to psychological emergencies. The Center' s policy is not to work with students who are intoxicated (intoxication defined as being above the legal limit of .08). After responding to an emergency, it is important that the counselor document the intervention/contact as soon as is reasonably possible following the emergency. If the student has not had previous contact with the Center, a new file should be created and a client number established to use for recording the contact in the database. In addition, the emergency is marked on the WIC steno pad, in case follow up is required by a different staff member who may not otherwise know that an emergency intervention has occurred, indicating the name and amount of time involved in the emergency intervention. Generally, if a counselor has been out on an emergency call one night/morning, another staff person covers the on-call for the next night to allow for some sleep/recovery time. This is usually best handled informally amongst the staff. The general guideline for emergency situations is that if there is any doubt about the best course of action to follow, consult with other staff. Consultation is absolutely essential when dealing with certain emergency situations which involve interpretations of the law, ethical guidelines, ambiguous circumstances involving some danger to self or others, etc. Additionally, the Center staff have agreed that consultation should be sought in any situation in which a clinician is considering deviating from any University or Center policy. Interns and staff new to the Center' s on-call system and emergency procedures are expected to consult in any emergency situation for their first several rotations.

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Emergency Meetings with Clients in Crisis Counseling Center As a general rule, counselors do not see clients in the Counseling Center after hours when front desk staff or other senior staff member is not available to provide coverage. Rather, the Infirmary is the best place to meet when possible. The Infirmary The University Health Service will usually allow clients to stay in the Infirmary for short periods of time when the client requires a “safer” place than their own residence. It is the most suitable place to meet with clients in crisis after regular office hours. However, the Infirmary is not a “safe” or “secure” environment as continuous supervision/monitoring cannot be guaranteed; clients who are actively suicidal are absolutely not appropriate for the Infirmary and must be sent to the Watauga Medical Center Emergency Room, or psychiatric hospital if clearly needed. To admit a client into the Infirmary, the nurses on duty should be notified and given a rationale for the request. Any notes or instructions for the nurses must be written in the client’s chart at the front desk. Most importantly, instructions for the nurses to follow in the event that the client leaves the Infirmary (which is unlocked) should be written, making certain to indicate whether a Center staff or the University Police are to be informed. It is also wise to get an explicit agreement from the client that s/he will not leave the infirmary without your consent, will not cause any harm to him/her self, others, or property while there, and will abide by Infirmary rules during his/her stay. The infirmary has limited hours on the weekends (when the majority of emergencies tend to occur), so at those times other options will have to be pursued. Watauga Medical Center Emergency Room The Center staff has permission to use the Watauga Medical Center ER to meet with students in crisis for times when the Infirmary is closed. It is not necessary for the student to be admitted, or go through ER medical evaluation procedures provided that the ER personnel are notified ahead of time the counselor' s name, the student' s name, and the approximate time that they will be meeting. Remember to specify if the student is not to be admitted to the ER to ensure that unnecessary procedures and costs (which can be quite higher than students are prepared to deal with) can be avoided.

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University Police Students may also be seen at the University Police station if it is not possible for them to find transportation to the hospital. The above options should be considered first, but the Campus Police have agreed to provide a room for interviewing if no other options are viable. They are often willing to transport students to the hospital should there be any medical need, though this is not an official policy. The Boone Police or the Sheriff' s office may be another option to provide transportation for students living off campus. Volatile Clients In the unlikely event that a client should become volatile in a counselor’s office, the front desk should be called, using the word "Cody" (for code) in any part of the conversation that feels natural/non-threatening. Specific guidelines are outlined in Appendix O as to how best another staff member can inquire about and follow up with any actions that may be necessary to ensure safety. The intention is that staff know there is a safety net available should a dangerous situation ever arise – hopefully it will never have to be used. Suicide attempts/gestures -- Notification of Parents Parents, or next of kin, are called, by default, if any life-threatening attempt is made or if the counselor feels a student is in danger. Parents (or next of kin) may be notified in the event of a suicide gesture even if there is no imminent danger, as per university policy. Seek peer consultation, and inform the Director and/or Clinical Director on all parent notifications. It may also be necessary to inform other agencies on campus and/or administrative personnel. Note that if students are going to be gone from their residence hall, residence life staff should be informed (without giving specific details); it is best to first inform the student that this is going to be done. If there has been a suicide gesture, the student and/or legal guardians should be informed of the university' s policy concerning life threatening behavior (Appendix P), as well as given a written copy (copies are kept in the emergency folders). Note: if a student has evidenced suicidal ideation or behavior and refuses service either at the Center or an outside resource, it is critical that it be documented that counseling was recommended, offered and refused by the student. This is potentially grounds for dismissal from the university.

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Sexual Assault Educating clients about the potential limitations of confidentiality in regards to reports of sexual assault incidents is crucial in cases of alleged sexual assault. Counselors'reporting responsibilities and those of other university offices may differ dramatically, and confidentiality is likely to be compromised to varying extents by the involvement of other university personnel. The university' s policy concerning when, and in what circumstances names and/or other details must be reported are outlined in Appendix Q. Recent legislation (i.e., the Cleary act) makes it clear that all reports of sexual assault that come to the attention of staff in the Division of Student Development must be reported. It is not always clear what circumstances, if any, would mandate division personnel to report a name. Both Counseling Center and Infirmary personnel are exempt from reporting responsibilities. Residence life staff and the university police have been informed that the on-call person is to be notified immediately if the victim is a student. If personal contact can be made before responding, the choice should be offered about whether it is acceptable to them to see a male/female counselor. If transportation is required, it is important to remind others involved to make informed decisions regarding the nature of information reported to the ASU police. The police may be required by university policy to report information (which potentially includes supplying a name to the administration) that would not be in the best interest of a victim who is unsure of his or her willingness to have the incident made known. A written copy of alternatives, and potential benefits/consequences of reporting, is provided in the emergency folder. If the person elects not to press charges to keep their identity unknown, they have the option to file a “blind report” with the police, so that at least information concerning the incident can be on record which might prove useful in future situations. Appendix Q contains a summary of the steps and approach to be taken when dealing with a sexual assault situation. Hospitalization Hospitalization procedures most often require that several phone contacts be made within a short period of time. It is always best to involve a second counselor in these cases, even if this means that a therapy session or other meeting must be ended early or cancelled. The standard practice of the Center is to notify next of kin, although extenuating circumstances may at times contra-indicate this (such as family history of abuse). In such cases, consultation is crucial to ensure sound clinical judgment.

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Involuntary hospitalization is very rare with the student population, but has on occasion been necessary. In these cases, counselors should request the assistance of New River Behavioral Healthcare staff, as they have an operating procedure in place to complete the necessary documentation, and can facilitate the process more efficiently than the Center. Appendix R outlines details of the process in the unlikely event that an involuntary commitment need be made by a Center staff. Psychological Withdrawals Psychological Withdrawals may be given for clients who are judged to be incapable of functioning adequately as a student, i.e., experiencing psychological impairment of such severity that there is need for immediate treatment or care that is beyond the scope of what may be provided at the university. Psychological withdrawals must be discussed with the Director or one of the Associate Directors; they are the only staff who have the authority to make the final decision to offer a psychological withdrawal. Any student considering a psychological withdrawal should be given a copy of the written criteria (Appendix S). If the student accepts, s/he signs a contract which stipulates that the student will: (1) remain out of school for a minimum of 6 months; (2) agree to receive treatment from a licensed mental health professional addressing the concerns which necessitated the withdrawal; (3) provide written documentation of having undergone professional treatment and complied with said treatment, when requesting to return to ASU; including a diagnosis, prognosis, and assessment of the student’s readiness to return to the unstructured environment of the university; and (4) meet with the Director or one of the Associate Directors prior to being allowed to register. The Center' s administrative assistant will draw up the contract, which must be signed by the student. A document to be given to the treating mental health professional, which outlines the documentation necessary for readmission, is also given to the student (Appendix T). A student who elects to take a psychological withdrawal receives “W”s on their transcript without any record of having left for psychological reasons. Once the contract is signed, the client is no longer considered a student and must leave the campus and residence hall (if they live on campus)—usually, their disposition will be to enter inpatient treatment or be taken home by parents. A memo indicating that the student has been granted a psychological withdrawal is sent to the Registrar. A staff representative of that office explains to the student everything that needs to be taken care of before they leave.

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A form of involuntary Psychological Withdrawal can be invoked in the extreme case where a student presents as a danger to self or others, but refuses treatment. In such cases, the student can be required to meet with the Administrative Health Officer (Dean of Students), who can stipulate that a student must pursue assessment and/or treatment as a condition of remaining at the university. The Director of the Center is the only person who can implement this procedure. Situations Requiring Notification of the Director/Associate Director The Director (or, in the absence of the Director, one of the Associate Directors) should be notified in any situation with University-wide implications, especially any situation with the potential to generate negative publicity for the Center, the Division, or the University. They should also be informed of any life-threatening situations or other extreme emergencies. Common Ethical Concerns Center clinicians adhere to the APA and ACA Ethical codes (a copy of the APA Code of Ethics is provided in Appendix U). Some of the more common concerns are outlined below. Dual Relationships Since some therapist-trainees are likely to seek therapy, and the Center is often their only option, the potential for dual relationships, though often inadvertent, is high. Special care is needed to avoid dual relationships at the Center. Some examples follow. Counselors do not supervise former clients, nor do they provide therapy to former supervisees. Counselors do not provide therapy to students who may be enrolled for a class they may be teaching. Graduate students from one of the counselor training programs at ASU do not engage in therapy with other graduate students from either of those programs, except in rare exceptions that must be agreed upon by senior staff. Part-time counselors who teach in one of the academic departments do not provide therapy for students from the same department. Consultation with other staff should be sought when there is a question about a potentially problematic dual relationship. Occasionally, the Center has received requests to provide therapy to troubled students in a department, and provide feedback about their use of, or progress in, therapy. The Center does agree to see such students, but does not report on therapeutic progress to other university personnel, especially when this may have consequences for a student’s academic standing. This

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policy should be made clear to both the client and the referring person—if confidential information is insisted upon, the student will not be seen at the Center, and should be given referral options outside of the university. Therapist-Trainee Clients If a student who could potentially apply for a future practicum or internship at the Center seeks counseling, a senior staff person, or pre-doctoral intern who is least likely to be compromised by knowing about this client should be assigned the case. It is best if this is a person who would be unlikely to be selected as a supervisor if the client were ever to work in the Center. If this decision involves any ambiguity, the case should be presented for peer review before being assigned. The client should also be made aware of the potential discomfort in working at the Center in a much different capacity than s/he would experience as a client. Outreach and Consultation All the clinical staff at the Center share outreach and consultation responsibilities. These duties are monitored and processed primarily by the Outreach Coordinator, although any staff member may field requests from the campus community. Outreach may include the following activities: disseminating general information about mental health issues; providing information about the Counseling Center services and resources; and providing programs, workshops, presentations, or general consultation. These activities are provided primarily to the campus community, although outreach programs may be offered to the general community where deemed appropriate by the Center staff. Generally, outreach is of a psycho-educational nature; consultation associated with the treatment of a present or potential client or activities designed for clinical training are considered clinical activities. Processing Requests Requests for outreach/consultation activities are generally directed to the Outreach Coordinator. However, individual staff members may be contacted based on their association with the person who calls or the topic matter requested. The individual staff members may either record the pertinent information themselves, or direct the request to the Coordinator. In either case, the requests are presented at the next staff meeting and staff members can volunteer for the

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activities that fit their interests and/or schedules. The Coordinator gives the copy of the request to the staff member(s) who volunteers, who should then confirm the date and topic with the contact person. When doing presentations, staff are strongly encouraged to have evaluation forms completed after the event to provide feedback for the presenter/s and the Center. When Residence life staff request programs for a residence hall, they are asked to combine several floors for one program to assure adequate attendance. If a program is still to be given for a single floor, the residence life staff is asked to deliver the program him/herself in consultation with Center staff; or, alternatively an intern, if interested, may provide the program. Bulletin Boards The Counseling Center maintains bulletin boards in the Student Union and the Quinn Center, in addition to the hallway outside the Center. Generally these are to advertise Center activities and paraprofessional programs. The Coordinator of Outreach is responsible for disseminating sign-up sheets for staff to bring materials to post in these locations. Once a staff member signs up for a two-month time slot, it is his/her responsibility to post the relevant information in a timely manner. Generally, materials should be put in the bulletin boards the first of the month and dated material should be removed within two class days following any advertised event. The keys for the Student Union and hallway glass case can be obtained from the vault key rack. More detailed guidelines can be obtained from the Outreach Coordinator. Residence Life Consultants One staff member and one or more interns are assigned to each of the Residence Life communities on campus. The consultants (formerly referred to as liaisons) to these communities participate in RD and RA training, RD meetings, and other community activities. These consultants serve as the primary contact person at the Center for the AC, RAs and RDs in their area who seek consultation services. However, any available clinical staff may respond to consultation requests if contacted. Uncle Sigmund Uncle Sigmund is the name given to the persona who offers help and advice to the campus community. This persona is represented by the staff of the Counseling Center throughout the

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year by offering on-line answers/advice to questions of a psychological nature submitted on the campus Web page. Uncle Sigmund Advisor Volunteers from the Center’s clinical staff answer questions submitted on-line to Uncle Sigmund. The coordinator of the Uncle Sigmund projects oversees the dissemination of each question via e-mail to a participating staff member, who then writes a response to the question, and forwards a copy to a second reader for proofreading, feedback, additional suggestions, etc. The reviewed/edited response is then returned to the Uncle Sigmund address with a note to the effect that it has been proofread, and thus is ready to be posted onto the Web page. Uncle Sigmund participants are encouraged to reply within one to three days so students can read answers to their question in a timely manner. As an aid to Uncle Sigmund volunteers, the Wellness Center has samples of responses on file from past years, as well as some “stock” answers. If a question is particularly perplexing, the respondent may want to solicit input from more than one other staff member to devise an answer that reflects sound mental health principles. Guidelines for Uncle Sigmund Responses Uncle Sigmund attempts to offer facts as often as possible, but may also offer advice, with care, based on sound mental health principles, and/or refers students to campus and community resources for more information, intervention, or treatment. Answers should avoid referring to Uncle Sigmund as “Uncle,” or referring to other information sources by name to avoid misinterpretation by an unknown audience (any member of the ASU community, or for that matter, the community at large, not just the submitter, has access to Uncle Sigmund statements and answers) Referral recommendations should be made to programs and not to individuals. Uncle Sigmund avoids giving specific advice, such as encouraging a student to drop a course. Rather, Uncle Sigmund should suggest meeting with an advisor to explore options, using good communication skills, and/or following a list of questions/concerns to be discussed. Some questions submitted to Uncle Sigmund may need to be edited to omit obscenities, conceal the identity of the author, shorten the question, correct spelling and grammar, and/or reduce redundancies. In some cases, there may be questions where the student requests

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anonymity, or there is too much identifying information, or the question is ridiculous, yet covers an important topic. Under these circumstances, the submitter’s identity may be omitted and the answer addressed as “Confidential Response to…” either the general signature, or a key word in the question. Some questions may just be omitted when they are clearly inappropriate or of distasteful humor, such as overly sexual or obscene content with no apparent psychological issue/concern to be addressed. The problems presented through Uncle Sigmund range from the frivolous to the gravely serious. Frivolity may be matched with humor. However, care should be taken to err on the side of caution if it is unclear whether or not the message, or the message writer, represents a significant concern. On occasion, situations of great seriousness will evolve. In those cases, every effort is made to communicate to the individual the advisability of calling or coming to the Counseling Center for a face-to-face talk. Accessing Uncle Sigmund The on-line advisor is accessed through the ASU home page. On the home page, students click on “Student Life”, then on “Uncle Sigmund Advisor.” The home page is relatively userfriendly and most students are able to find their way through the steps needed to ask questions, and access previously submitted questions and the Uncle Sigmund responses. When a student submits a question, it is accessible only to Uncle Sigmund staff, but the answers and questions that have been reviewed/edited are pasted on the Web site and can be read by anyone who accesses the ASU home page. Answers are displayed according to the subject and date, so readers can keep up with the answers they have already read and as well as whatever questions they may have asked. Staff Expectations This section contains general policies, procedures, and expectations for all clinical staff related to employment in the Center. Exceptions to these expectations should be negotiated with the Center Director prior to implementation.

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Schedules Clinical schedules are now kept electronically through Protégé. Standard working hours at the Center are from 8:00 a.m. to 5:00 p.m. Occasionally, staff may elect to arrive as late as 8:30 to compensate for time spent in evening activities. Schedules are recorded electronically, and clinicians are responsible for making sure that their schedules are accurate and up-to-date. If a staff member will not be in the Center prior to 8:30 a.m. and has not already marked him/herself out, s/he must call to inform the front desk staff. When a staff member is absent due to illness or emergency work, front desk staff should be notified by 8:30 a.m. as well so that appointments may be cancelled for the day. Front desk staff will mark an absent staff member’s electronic schedule so that all staff can be aware of the staff member’s absence. One staff member is designated to be on-call for emergencies during the lunch hour (12:00 noon to 1:00 p.m.). Staff members may have individual sessions, groups or other activities after 5:00 p.m., but are responsible for arranging their own front desk coverage during that time. Trainees do not conduct sessions or groups after 5:00 p.m. unless arrangements have been made for senior staff to be present in the Center. Clinical staff members are expected to carry a caseload of 18 to 26 direct service hours. This, however, is a general guideline and exceptions may be made for increased administrative responsibility and preparation for special events (e.g. licensing exams, professional presentations, etc.). Direct service includes individual and group therapy, walk-in clinic, and clinical supervision. Specific caseload responsibilities are negotiated with the Director. Leave Leave time is best taken during the semester breaks and summer sessions. Staff may sign up for leave times on a first come, first served basis during the summer, checking that there are ample clinical staff available to provide coverage for the Center during the period of desired leave time. Leave time should be cleared with the Director by completing a “Leave Request Form” (see Appendix V). Adjunct Staff At times, faculty from various academic departments request the opportunity to provide clinical services at the Center on a part-time basis. The Center staff and/or Director must approve adjunct staff. In the past, the Center has housed and administered the Clinical

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Psychology Practicum I in exchange for faculty members to work in the Center part-time during the Fall and Spring semesters. Recently, this exchange has taken the form of funding for internships from the clinical psychology program, and the HPC department has provided parttime therapists in exchange for Center staff teaching in that department. This is negotiated at the beginning of the year. Adjunct staff members have generally been expected to carry 5 or 6 individual therapy hours. Leading a therapy group is also an option that can be negotiated with the Groups Coordinator. Other specific activities and scheduling are negotiated with the Center Director and/or administrators of specific Center functions (e.g. staff interested in biofeedback negotiate with the Biofeedback Director). Part-time staff members are expected to attend weekly Peer Supervision Meetings, 8:00 to 9:00 a.m. on Tuesdays. Private Practice Staff may not engage in private practice for independent profit in the Center (as prohibited by state law). Those wishing to have private practices outside the Center may do so, but must provide their own liability coverage for such activities. It is possible to work non-standard hours to fulfill Center responsibilities and allow for private practice during standard work hours, but this must be negotiated with the Director. Staff may not see enrolled ASU students in private practice. Position Responsibilities Each of the senior staff agrees to take some form of administrative responsibilities. These areas are: director, clinical director, training director, outreach and consultation coordinator, masters’ level training coordinator, groups coordinator, peer career coordinator, wellness program coordinator, research coordinator, assessment coordinator and alcohol and drug assistance coordinator. The extent and nature of these duties is negotiated with the Director. The general responsibilities and activities assumed for each of the Center' s designated positions are outlined in Appendix W. All Center staff report to the Director of the Counseling Center, and the Director reports to the Vice-Chancellor for Student Development. All Staff Psychologists/Counselors provide the following services: 1. Counseling and psychotherapy to students (individuals, couples, families, and groups) 2. Intake assessments 3. Administration and interpretation of psychological tests

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4. Crisis intervention and on - call coverage 5. Presentation of programs and workshops 6. Supervision and training of practicum students and interns 7. Consultation with faculty, staff, and students regarding psychological issues 8. Service on university committees as needed Professional Development Funds are provided in the Center budget to support staff in seeking professional development that is related to work in the Center. Support funds are allocated for the Director to attend the AUCCCD conference, the Training Director to attend the ACCTA conference, and the Clinical Director to attend the ACCCCS Conference. All remaining funds are divided among the senior clinical staff to support attendance at conferences and workshops, and professional memberships. Registration forms and travel arrangements should be submitted to the office manager well in advance of the event to be attended in order to arrange for reimbursement. The office manager and/or Director should be consulted regarding the acceptability of activities and travel arrangements (e.g. state budget standards limit the amount of hotel and food expenses). Teaching Staff members are generally permitted to teach one course per year (provided the demand for clinical services at the Center can still be met) and are allowed some release time to teach the course. Interested staff must consult with the Director before agreeing to teach any ASU course. Teaching is generally arranged in exchange for faculty working part-time as clinicians in the Center. Licensing Staff members are expected to be licensed or certified, or pursue licensure or certification when state law requires it. Specifically, North Carolina law requires practitioners with psychology degrees to pursue licensure as a practicing psychologist at the doctoral level or psychological associate; those with other Master' s degrees must pursue the licensure associated with their degrees. It is expected that certifications required for specialized activities that staff may conduct at the Center will also be pursued. Staff members are responsible for having copies of their licenses and periodic renewals placed in their Center personnel files.

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Supervision Supervision is provided by Center staff to any staff member requiring supervision by state law. Supervision requests and supervisor preferences should be made to the Training Director so that assignments may be coordinated with trainee supervision needs. Administrative Support Clerical and administrative support of staff members'work is available from office personnel and work-study assistants. Requests for work tasks should be made to the office manager who will allocate the tasks to other office staff and assistants. Deadlines for work tasks should be specified. The hours available from work-study students varies greatly from semester to semester, as well as individual abilities to perform such tasks. The office manager should be consulted as to whether a certain type of task or time frame is a reasonable expectation for them. Front Desk The front desk is a professional workspace (and the only work space) for the office staff. It is important for clinical staff to be mindful of respecting this space. Confidential information should never be discussed in this area, and socializing at the front desk should be kept to a minimum, unless requested or approved by the front desk staff. Meetings Staff Meeting The weekly staff meeting serves to share information, discuss administrative changes or requirements, announce new procedures, the availability of groups or clinical programs, and generally to keep the team informed about events within the agency and on campus that might affect their work. We strive to start meetings on time, and no later than five minutes after the time selected to begin. Efficient use of time is important. Beginning with the 2004-2005 academic year, the following guidelines will be used for staff meetings: The weekly staff meeting will generally last for one and one-half hours, with the Director (or an Associate Director in the Director’s absence) facilitating

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Each week’s staff meeting agenda will be available electronically (G:\\Redcross\User\Shared\Staff Meeting Agenda) and staff members should add agenda items to the electronic agenda prior to the meeting The agenda will consist of the following categories: •

Accomplishments

•

Announcements

•

Discussion Items

•

Crisis Check-In

•

Others

At the conclusion of a discussion, the most relevant person should summarize what needs to go in the minutes about that discussion We will make an attempt to refer people to previous meeting’s minutes rather than repeating entire discussions. Everyone is responsible for knowing what was decided in previous meetings We will attempt to identify discussion items which need to go to committee before spending too much staff meeting time on them A designated staff member will review and approve minutes the same day as the staff meeting so they can go out quickly to all staff and trainees Peer Supervision Peer Supervision meetings take place on Tuesday mornings at 8 a.m. As the title suggests, these meetings are primarily for clinical case consultation and professional issues. In order to avoid unwieldy discussions, the staff will divide into three smaller groups meeting in several designated offices. This meeting will serve as the place in which pre-doctoral interns present their formal case presentations. This meeting will also serve for peer review regarding the ten-session limit and the need for referral out of the Center following the newly established treatment guidelines. Therapists should present cases after the sixth or seventh session if they wish to go beyond ten sessions with a client. Those not presenting should ask questions about goals and how the therapist will know when they are finished with the client.

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Psychiatric Consultation Psychiatric Consultation meetings are scheduled at an agreed upon time each semester (recently Mondays at 8:00 am). All therapists should check the calendar to see if they have a client seeing our psychiatric consultant that day. If one of their clients is scheduled to see our psychiatrist, the therapist should attend the meeting or arrange for someone else on staff to be an informed substitute. Committees In order to better facilitate decision making at the Center, five committees have been established. They are Clinical, Training, Outreach, Research, and Image. Each clinical staff member is expected to serve on a minimum of one committee. The chair of each committee is the Director/Coordinator, i.e. Clinical Director, Training Director, Research Coordinator and Outreach Coordinator. These committees discuss policies, make decisions, and bring their plans/recommendations to the full staff for formal approval. Meetings of these groups are scheduled at the beginning of the semester. Annual Performance Review The director will complete clinical staff evaluations for each clinical staff member on a yearly basis. During evaluation meetings, staff should be prepared to discuss the amount of direct service they plan to provide and their goals for the next year. The Annual Performance Review form is found in Appendix X. Training Practicum The Center currently hosts a limited number of students to engage in Clinical Practica. Graduate students in counseling, student development, and health psychology may also participate in training through Peer Career and Wellness Center programs. The Masters-Level Training Manual provides a detailed description of the activities and expectations of practica trainees at the Center.

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Masters Level Externship The Center offers externship opportunities to students in Clinical Psychology, Health Psychology, Counseling, and Student Development as well as other therapist-training programs. Details of these internships can be found in the Masters-Level Training Manual. Pre-doctoral Internship The Center houses an internship for students completing requirements for a doctoral degree in clinical and/or counseling psychology. The Pre-doctoral Internship Training Manual details this training program.

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APPENDICES

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Appendix A: Mission Statement The function of the Appalachian State University Counseling and Psychological Services Center is to provide the university community with mental health services aimed at maximizing the personal growth and development of its members. These services are primarily offered to students and include a wide variety of preventive, remedial, educational, and crisis management activities. The Counseling and Psychological Services Center is located organizationally within the Division of Student Development and reports directly to the Vice Chancellor for Student Development. The major activities of the Center include: individual and group counseling services, 24-hour crisis management, growth group experiences, testing services, outreach program development, training, teaching, consulting, research, and staff development.

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Appendix B: Severity Rating Descriptors Please use the following code in providing a severity rating for clients upon completion of the WIC intake. On this scale, from 1 - 5: a 5 indicates minor severity; 3 moderate severity; and a 1 represents severe impairment. This scale was adapted from the global assessment of functioning (GAF scale) outlined in the DSM, Axis IV & V. (5) If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument or relationship breakup). There is no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). (4) Some mild symptoms (e.g., depressed mood or insomnia), or some difficulty in social, occupational, or school functioning. Generally functioning pretty well; has some meaningful interpersonal relationships. Acute events: breakup of romantic relationship; started or graduated from school; child left home. Enduring circumstances: family arguments; dissatisfaction being at the university; place of residence is highly disruptive or stressful. (3) Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with roommates). Acute events: divorce; birth of first child. Enduring circumstances: withdrawal from school; poverty; extreme substance abuse or addiction; eating disorder (without severe disruption of daily functioning). (2) Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or moderate difficulty in social, occupational, or school functioning (e.g., no friends, failing academically). Acute events: marriage; marital separation; miscarriage. Enduring circumstances: marital discord; serious financial problems; trouble with administration; being a single parent; severe family dysfunction/conflict, substance addiction or eating disorder with significant disruption of daily functioning. (1) Some danger of hurting self or others (e.g., suicide attempts, frequent violence, manic excitement) or occasionally fails to maintain minimum personal hygiene or gross impairment in communication (e.g., largely incoherent or mute).

40 Appendix C WIC Procedures Checklist Please use the following checklist as a reminder for the procedures to be followed after seeing clients during Walk-In Clinic: If the student is being referred for individual or couples’ counseling, give the student the “Individual Counseling Information” letter which explains to the student that they need to call to find out about their scheduled appointment. You may keep copies of this letter in your office or you can find copies at the front desk If the student is being referred for individual or couples’ counseling, their name will appear on the Individual Counseling List in the database (as long as their “primary staff” remains “no assignment” after WIC) If the student is being referred for group therapy, schedule the student for a screening session as directed in the Active Groups list on the database. If group is the student’s only referral, change their primary assignment in the database to the group. If the student is being referred to services other than individual or couples’ therapy, change the primary assignment to the clinicians’ name (e.g., Kit for Biofeedback, Group name for Group). If the client is a returning client of yours and you are continuing with the client rather than referring them through case disposition, please change the primary assignment to you. This keeps the client’s name from showing up on the Individual Counseling List at Case Disposition. Indicate the recommendation for the student next to the student’s name on the steno pad where students’ names are listed when they present for walk-in. The appropriate abbreviations are: • • • • • • • •

T – individual or couples’ therapy G – group therapy R – referred out NA – no service recommended or needed D – dietitian B – biofeedback SA – substance abuse services PR – client will be presented at Peer Review before a decision is made

In some situations you may refer a student for more than one service, in which case you can use multiple abbreviations (e.g., B/T for a client referred to biofeedback and who needs to be placed in individual counseling) Remove the OQ-45 and “Health & Wellness Checklist” from the file and place them in the tray labeled "OQ-45s to be scored/entered” to the left of Nanette’s desk. These documents will be returned to the files after they have been entered into the database by the student workers If the student is being referred for individual, group or couples’ therapy, complete the “Walk-In Clinic Assessment” in the database, print it, place it in the hard copy file and place the file in the tray labeled “Case Disposition” located to the left of Nanette’s desk Clients referred for individual/couples therapy should be told they will be placed as quickly as possible into the first appropriate and available opening following their walk-in appointment. If they are not placed on the first Wednesday or Friday following their walk-in, they should call on the next Wednesday or Friday to learn of their placement. Also, students are sent a note informing them of their placement on Wednesday and Friday mornings following case disposition. This note tells the student that if they miss their appointment or do not confirm their appointment within one week of the notice, the appointment time will be re-assigned and they will need to contact the Center to re-initiate services. Please keep in mind that as the semester progresses, students may experience a short delay in getting assigned to a therapist. Thank you for your attention to these details. Following the above procedures will ensure appropriate follow-through for clients and will speed the process of case disposition on Wednesday and Friday mornings.

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Appendix D: Treatment Guidelines The Center attempts to provide therapy services within a time-limited framework as much as possible. Listed below are both inclusion and exclusion criteria to be considered when conducting intake assessments during WIC. These guidelines are offered to assist the clinician in making decisions regarding whether or not Center services should be offered to students who present at the Center. Inclusion Criteria (Clients should possess some of the following criteria to be considered eligible for treatment in the Center): Client presents difficulties with a situational problem or a developmental transition. Client is able to identify focal conflict(s) or specific areas of difficulty. Client demonstrates the ability to focus on goals. Client possesses high motivation for change. Client expresses a desire for symptomatic relief. Client can introspect, self-monitor and experience feelings. Client evidences the ability to develop trust, be open and relate to others/therapist. Client’s prior treatment history is not severe. If the client has had previous treatment, there has been a positive response and client is able to verbalize such. Client exhibits evidence of previous coping ability. Client demonstrates the capacity for self-responsibility. Exclusion Criteria (Clients who possess two or more of these criteria must be presented in Peer Supervision before being offered services in the Center.) Client is likely to require emergency intervention, crisis services or extensive case management. • Client is likely to involve other staff due to case management difficulties (emergency care, etc.) • Client is likely to need 24-hour coverage • Client is likely to require hospitalization during therapy • Client has had a suicide attempt in the last six months • Client has been hospitalized for psychiatric reasons within the last three months • Client has chronic and/or present self-destructive behaviors that are life threatening • Client has an alcohol or drug addiction that requires more intensive treatment than our Center provides Client does not appear to benefit from therapy • Client does not appear motivated to change, evidenced by. . . . • Client has clearly not profited from previous counseling services

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Client is likely to require more than 1 session per week or would not tolerate extended breaks from therapy (e.g., semester or summer break) • Client is likely to need therapy more than once per week • Client is not able to maintain prolonged periods without therapy inherent in the academic calendar of a university counseling center Client is likely to require long-term therapy • Client’s needs are judged to be of a long-term nature, i.e., more than a calendar year • Client has a longstanding or severe pathology (e.g., severe personality disorder, present or chronic psychosis, dissociative episodes). • Client has chronic or multiple stressors that would impede short-term interventions • Client’s GAF is chronically low Client is unable to meet the demands of active participation in therapy • Client and therapist are unable to arrive at mutual therapeutic expectations • Client appears unable to form a relationship • Client will not participate in assessment, including personal history assessment Client requires expertise/resources unavailable in Center • Client’s issues require expertise or resources not sufficiently available at the Center • Client’s presenting issues may involve legal proceedings requiring a clinician to testify in court (e.g., custody hearing, court-mandated treatment) When in doubt about whether or not to offer services to a student based on the above criteria (e.g., the client meets three of the exclusion criteria categories, but also possesses several of the inclusion criteria which seem to offset the exclusion criteria), the client should be scheduled for an extended assessment session with the same intake clinician. Before the next session, the intake clinician should present the case for discussion in Peer Supervision. Presenting clinician should bring copies of the Treatment Guidelines to aid in discussion in Peer Supervision. Please note that any student may (and should) be referred out directly from WIC if, in the clinician’s judgment, they meet a substantial number of the exclusion criteria without also possessing a significant number of inclusion criteria. Alternatively, in some instances, a clinician may decide that a referral to community resources may be in the best interest of the client, even if the client meets only one of the exclusion criteria. Such decisions may be made at the discretion of the intake clinician without consulting their Peer Supervision group. Cases forwarded to Case Disposition team who fall within the above guidelines and who have not been presented to Peer Supervision will be referred back to the intake clinician. The Center attempts to provide therapy services within a time-limited framework as much as possible. The following guidelines are offered to assist in making decisions regarding services offered to students who are likely to require long-term care or make little progress with the services available at the Center.

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Appendix E: Walk - In Flow Chart Client Referred to Group or Individual Therapist From WIC

Client shows for First Appointment

Therapist Decides on Follow – up For Subsequent No Shows Or Cancellations

Follow No-Show Policy

Terminate if No Contact within 48 hours

Replace Client at Bottom of Individual Counseling List if they contact Center within 48 hours

Client No Shows or Cancels without Re-scheduling

Therapist Sends Note to WIC Counselor Who Decides …

Make Personal Phone Call (Client May be at Risk)

Terminate

Reschedule, Refer or Make Other Arrangements

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Appendix F: Policy on Release of Counseling Center Records It is the policy of the Counseling and Psychological Services Center that confidential client records may only be released to a licensed or certified mental health professional (e.g. psychologist, psychiatrist, counselor, social worker or psychiatric nurse) with the client’s signed permission. The client record is the property of the Counseling Center rather than the client. If a student wants access to his/her file, it must be reviewed in the presence of a counselor or his/her designee. This should be done in a Counseling Center office. Test data, profiles, and symptom checklists are not made accessible. An interpretation of test data must be made by a qualified professional. If a counselor/ therapist believes that access to the records would be harmful to the student’s mental, physical, or emotional health, access may be denied to portions or even the whole file. If the counselor believes that access to files could lead to the harm of others, access may be denied. When requests for records are received from insurance companies, military personnel, or security clearance personnel (e.g. FBI, CIA), we will only release a file to a licensed mental health professional, with written permission from the client. With written permission, we will release information that the student attended counseling and the number of sessions attended. We will not make recommendations on a client’s suitability for service or security clearance. When we see students as clients, we see them for treatment. We are not seeing them for assessment or evaluation to make decisions about their suitability for jobs. Such evaluations require different techniques and skills. We will require a direct contact with the client in addition to the written permission before verifying attendance to therapy. From time to time, individuals walk into the office unannounced with a release of information expecting to receive records on the spot. That will not happen. Licensed clinical staff must process and make decisions about release of files. Office staff cannot make such a release. Records may also be released if court ordered.

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Appendix G

INDIVIDUAL COUNSELING FEEDBACK

Counseling and Psychological Services Center Date:_________________________ According to our records, you have worked with __________________________________ at the Counseling and Psychological Services Center. We would be very appreciative if you could take a few moments to provide the following ratings and comments about your experience. Thank you in advance for your help. 1) In general, I thought my relationship with my counselor was . . . Excellent 1

2

3

5

6

Very Poor 7

5

6

Strongly Disagree 7

5

6

Strongly Disagree 7

5

6

Strongly Disagree 7

4

5

Strongly Disagree 6 7

4

5

6

4

2) I would recommend my counselor to a close friend . . . Strongly Agree 1

2

3

4

3) The counselor' s blend of challenge and support was helpful to me . . . Strongly Agree 1

2

3

4

4) As a result of this counseling experience, I feel better about myself . . . Strongly Agree 1

2

3

4

5) As a result of counseling, I understand myself better . . . Strongly Agree 1

2

3

6) I feel more able to cope with issues and conflicts . . . Strongly Agree 1

2

3

Strongly Disagree 7

7) You probably had certain counseling goals when you contacted the Counseling Center; how successful do you think you were in reaching these goals? Very Successful 1 2

3

4

5

6

8) Do you think the services you received at the Counseling Center have contributed to: • Your remaining at Appalachian State? YES_____ NO_____ • A greater ability to study and concentrate? YES_____ NO_____ • Improved academic performance? YES_____ NO_____ • Increased class attendance? YES_____ NO_____ • Your becoming more involved at Appalachian? YES_____ NO_____

Very Unsuccessful 7 N/A_____ N/A_____ N/A_____ N/A_____ N/A_____

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9) What aspects of the counseling experience were the most helpful to you? Is there one incident or one counseling session that stands out in your memory as particularly valuable or rewarding for you?

10) What aspects of the counseling would you have changed? Is there an incident or counseling session that you could identify as being particularly negative or difficult for you?

11) I feel that the service I received from the front desk staff at the counseling center was . . . Excellent 1

2

3

4

5

6

Very Poor 7

12) When you first came to the Counseling Center, you were seen in the “Walk-In Clinic”, a short interview with one of the Center’s counselors to assess your desire and potential options for services here. How satisfied were you with this service and your interactions with the counselor at the time? Excellent 1

2

3

4

5

•

Any comments about this experience?

•

Anything else you would like to say about the Counseling Center?

6

Very Poor 7

Name (optional): __________________________________________ Thank you very much for your time and consideration in helping us to evaluate/improve our Center!

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Appendix H: Session Extension Request Form for Peer Review 1.

Client Name: Diagnosis: Presenting Problem: GAF: Severity Rating: OQ Scores (earliest to latest)

2.

Counselor Name:

3.

Counselor’s Supervisor (if applicable):

4.

Please indicate the reason(s) your work with the above client requires more than 10 sessions.

_____A. The client is almost finished and it doesn’t make sense to cut him/her off or to refer out at this point. _____B. The school year is coming to a close and the student who needs ongoing counseling will be referred to someone when classes end. _____C.

The student needs additional work, but no appropriate referral can be found.

_____D. The student was assaulted on campus and was so traumatized that longer term intervention is required and the school bears a greater responsibility in such cases. _____E. Other:___________________________________________________________ _________________________________________________________________________ 5. How many additional visits are you requesting? 6. What are the goals and treatment plan for the additional sessions?

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7. What referrals have been considered?

Why are these not sufficient or appropriate in this case?

8. How will the sessions lead to either termination or referral?

9.

How will you know when you are finished?

Decision reached by Peer Review Committee: _____No extension. Termination after one additional session. Referral made and date?_____________________________________________________ _____Extension granted Number of sessions?_______ Action required when extended session limit is met. _____________________________________________________________________________ Signatures of Committee members: ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________

Date________________________

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Appendix I: Psychiatric Referral Criteria 1) No referrals off of Walk-In except in extreme emergencies -- i.e. suicidal, psychotic processes, inability to function, medical emergency. Referrals should be made only after a minimum of three sessions of therapy/assessment for purposes of assessing diagnosis, client motivation for ongoing therapy and specifying referral questions. 2) All referrals for ADHD medication prescription should follow the protocol outlined in the Clinical policies and procedures; do not refer to the Center psychiatrist. 3) Please give careful consideration to the necessity of psychiatric consultation using the following guidelines: Is client’s ability to profit from therapy significantly compromised without the use of medication? Is there evidence of severe deterioration in daily functioning? Presence of psychotic processes? Is there significant potential for suicide, or harm of self or others without psychiatric intervention? Motivation for therapy separate from desire for medication is high. Mild depression/dysthymia/anxiety should first be offered outside referrals if psychiatric consultation is desired. Is there a significant question concerning current prescription/use of medication? If ongoing care is going to be required -- i.e. bipolar, and other chronic conditions, immediate referral out should be the first option considered. 4) All staff should consult with the psychiatrist, or if unavailable, the Director or Clinical Director in particularly questionable cases prior to scheduling an appointment with the psychiatrist. It is important to consider the current psychiatric caseload/availability of consultation to make sound clinical judgements for the optimal use of this limited resource. Practicum students and interns should not make psychiatric referrals without consulting with senior staff supervisors. 5) When clients are scheduled to see the psychiatrist, the primary therapist’s name should be written next to the client’s name on the schedule. Hopefully this will facilitate staff keeping

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tabs on clients who are not attending therapy sessions, but have scheduled psychiatric appointments. If clients scheduled for a psychiatric appointment are not attending therapy sessions regularly, be sure to notify the psychiatrist. If a client must be canceled in order to make a space for an emergency in need of an immediate appointment, an attempt will be made to consult with the client’s therapist first. Since this will not always be possible, it would be best to make a note on the psychiatric referral form if the appointment is considered crucial. Any notes for the psychiatrist should be placed on top of the medical documents in the file so they can be easily spotted by the M.D. When clients are scheduled for a psychiatric appointment, they should be given a Request for Consultation for Counseling Center Client (see next page) with the appointment time written in. Clients who are referred by Health Center physicians may consult with the psychiatrist provided that there has been an intake assessment and the WIC therapist deems is appropriate.

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Request for Consultation for Counseling Center Client Service Requested: Psychiatric ______

Medical/Infirmary ______

Dietician/Wellness Center ______

Referring Therapist:

Client Information Client's Name:

Date requested:

Counseling Status: _____ Group Therapy _____ Individual Therapy _____ Wellness Center

Therapist/Group: ___________________________________ Therapist: __________________________________ Therapist: _________________________________

Service Requested: _______ Diagnostic Evaluation Dietician Session

_______ Medication Evaluation

Referral Question(s):

Specific Symptoms & Known Medications:

Additional Comments:

_______

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Appendix J

CONSENT TO RELEASE INFORMATION Student Health Services

I,

Counseling and Psychological Services , authorize the staff of the above agencies to

Print Patient’s Name

freely share information with each other regarding any details of my case and treatment. Signed:

Patient

Date: Date:

Witness

REFERRAL INFORMATION

Referring Clinician

Date:

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Appendix K: Single Assessment Report Assessment Administered: Date of Administration: Assessment Results Part A: Reason for Assessment (brief statement as to why the assessment was conducted). Provide a brief description of symptoms (duration, impact on client):

Part B: Results Valid Profile:

Invalid Profile:

Not applicable:

Assessment Summary (Highlight clinically significant results. Highlight whether or not results are supported by what has been observed in client and/or supported by client statements):

Part C: Recommendations and Diagnosis

Signature:

Date:

Supervisor’s Signature:

Date:

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Appendix L Career “Prescription” Self-Assessment Resources to utilize the following Peer Career

Please allow resource(s): DISCOVER Self-Directed Search Work Values Inventory Worksheets: Assistance Needed:

Please interpret this assessment. Please administer the assessment and send it with the consumer for my interpretation. Please administer the assessment and deliver it to the Counseling Center for interpretation. Career Information Resources Please help this consumer research the following careers:

Suggested Resource(s): DISCOVER CIN Internet

O*NET Experience On Line

CPPlus Books

Communication _____ A signed release form is attached allowing Peer Career Personnel to communicate with me in the Counseling Center regarding this consumer. No communication with Counseling Center Personnel is requested at this time.

Counselor:

Date:______________________

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Appendix M Individual Counseling Information Decisions about assignment of clients to therapists for individual counseling occur each Wednesday and Friday morning. Most new clients are assigned to a therapist on the first Wednesday or Friday following their intake appointment. To find out about your scheduled individual therapy appointment, we ask that you call the Counseling Center (262-3180) after 10:00 am the first Wednesday or Friday following your intake. We will also inform you via campus mail of your scheduled therapy appointment. The appointment notice will be sent to your ASU Post Office Box Number; please be sure to check your mail for the letter. If you have not already called the Center to find out about your scheduled appointment when you receive this notice, please contact the Center as soon as possible (preferably some time that day or the next) between the hours of 8:00 am and 5:00 pm, Monday - Friday to confirm your scheduled counseling appointment. If we do not hear from you within one week of the date the notice was mailed, or you miss your scheduled appointment time (whichever comes first), we will not be able to hold this appointment time for you, as we are working to get as many people as possible in for counseling services as quickly as we can. If you are experiencing unusual emotional distress before you have been scheduled for a therapy hour, you may return to see a counselor during our walk-in clinic hours (1:00 – 4:30 pm, Monday through Thursday, and 1:00 – 3:30 pm on Friday). These sessions are usually 20-30 minutes and are offered on a first-come, first-served basis. It is usually best to call first to let us know you are coming; the staff will do their best to see that the time you must wait is as short as possible. We are making every effort to serve students as well and efficiently as we can, and appreciate your patience when needed. For those of you who experience a delay in being matched with a therapist, we know it can be frustrating (perhaps you thought about it for a long time before actually coming, or came in very ready to start). Although we cannot predict exactly when an appointment time will become available, the earlier in the semester you come to the Center, the more quickly you are likely to be assigned to a therapist. If you do have to wait for an appointment time, most students experience no more than a slight delay in being scheduled for their first appointment after intake. If you have specific concerns about this procedure, you may contact the Clinical Director of the Counseling Center, Dr. Carol O’Saben at 262-3180. Sincerely, The Counseling Center Staff

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Appendix N: Counseling and Psychological Services Center Emergency Services The Appalachian State University Counseling and Psychological Services Center provides a 24 hour emergency on-call system when classes are in session. We define an emergency as an “acute clinical situation in which there is an imminent risk of serious psychological or physical harm to self or others unless there is some immediate intervention.” Emergency situations would include suicidal or homicidal crisis, sexual assault or rape, domestic violence, deaths, serious accidents, fires, explosions, or other similar events. Sometimes an assessment may be made by talking to an individual in an emergency situation by telephone to determine if on-site contact is required. Our emergency service is not a “crisis hot line.” Students who are emotionally distressed and simply want to talk to someone would come to the Counseling Center during regular office hours 8 a.m. to 5 p.m. Monday – Friday. When on-site contact is required, the on-call counselor may meet with the student at the emergency room at the Watauga Medical Center. Such a meeting does not require admission to the emergency room. Under special circumstances, the on-call counselor may meet with a student at the police station, or the Student Health Center when open. Counselors do not go to the domicile of students. A same-sex counselor can usually be provided but a specific individual counselor cannot be requested. We do not intervene with students who are intoxicated or under the influence of drugs. A counselor can have little impact on students who are “high.” Some such individuals may need medical attention or to be kept safe in a hospital or other secure environment, but a psychological intervention would serve little purpose. Intervention will be offered when the student is sober or no longer under the influence of drugs, when such services may be of some benefit to the student. If a psychological emergency occurs Monday – Friday, 8 a.m. to 5 p.m., contact the Counseling and Psychological Services Center in the Annas Student Services Building (the same building as the campus post office) or call (828) 262-3180. If an emergency occurs outside of the above hours, contact the on-call counselor by calling University Police at 262-2150. They will then notify the on-call counselor to respond to the name and number given. When classes are not in session, the emergency room at Watauga Medical Center would be the most appropriate source of help. 12/99

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Appendix O: Volatile Clients -- Safety Procedures In extreme cases where there is potential danger to a clinician, the following steps are to be taken to ensure the safety of all colleagues. It is hoped that the system will never have to be used; it is perhaps more important to have the security of knowing that back-up is available in the unlikely event that it may ever become necessary. If it is known that a client who is being seen may potentially threaten the safety of a staff member, all staff at the front desk should be informed. It is essential that a senior staff clinician who is able to respond immediately also be made aware of the situation. The staff seeing the client in question should consider if they would feel safer to have a colleague call into their office during the session; if so, alert the front desk, and another senior staff will be involved. If a therapist becomes concerned about his/her safety during a session, they should tell the client that they need to call the front desk to check on something. Say anything that comes naturally; it is only necessary to use the word "Cody." For example, "Could you tell Cody that I will be a little late for our meeting?" The word "Cody" will alert others that there is an emergency situation where immediate assistance is needed. The front desk staff should first ask if there is need to call the University Police, then immediately inform a senior staff of the situation -- do not hesitate to interrupt a session or meeting -- no delay. A potentially dangerous situation takes precedence over everything else. The senior staff should be prepared to call into the clinician' s office, and ask a series of yes/no questions to ascertain what nature of assistance, if any, is needed. If there is any doubt, involve another senior staff either to make the call or to be present to help with decision-making, no matter if that means interrupting a session/meeting. Yes/no questions give the therapist at risk the prerogative to avoid talking in front of an agitated client should that be important to avoid escalating a volatile situation. The first priority is to attempt to guide the clinician out of the office safely: “Can you tell your client that you need to come out to the front desk to answer/respond to a quick question/phone call?” If the clinician is unable to leave the office and is at risk, they are

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likely to be in an agitated state themselves, so calmness in asking follow up questions is crucial. Yes/no questions are aimed at immediate clarification of safety needs, such as . . . -- Are you in danger/being threatened? -- Do you need someone to come in? -- Would you like me to call back in x minutes? -- Is there a need for more than one person to intervene? -- Should we knock first? -- Are the police needed? . . . Etc. The intervening senior staff should inform the clinician in session of their plan of action before hanging up, i.e. "I am coming in now with John, we will knock first, then enter immediately after we knock." The consent of the clinician at risk should be obtained before enacting the plan, "Is that okay?" In the highly unlikely situation where there may be the potential for needing to restrain a client, the police should be called, even if it is not possible to wait for them before intervening (i.e. if a clinician were in immediate danger of physical harm). In such cases, there should be at least 2 other staff members involved who have some experience/training in dealing with physical violence. The Clinical Director and/or Director should immediately be informed of all such situations in which these procedures are utilized. They, in turn, will make the decision about notifying the office of the Vice Chancellor for Student Development.

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Appendix P: University Policy on Suicidal/Dangerous Behavior This policy statement is reproduced from the Appalachian State University Student Handbook of Rights and Responsibilities): The stress of the college experience and the normal developmental issues of young adulthood place some students under emotional pressure that occasionally manifests itself in an attempt by the student to take his or her own life. It is the philosophy and practice of the university to assist students with the stress and developmental issues of college and to render assistance to students by helping them resolve these issues. Among other offices, the university staffs and maintains the Counseling and Psychological Services Center. It is charged with the responsibility for assisting students in need of counseling and psychotherapy. It is the policy of the university to treat all attempted suicides as serious regardless of the degree of lethality involved in the attempt. The university is not prepared to judge the degree of sincerity in the attempt but will view the attempt as an indication that the student has on-going problems which are likely to interfere with the student’s ability to make positive, self directed choices and to perform academically. In instances where a student attempts suicide or exhibits life-threatening behavior, the university is concerned first for the student’s safety and well being. At the time a student attempts suicide, the university will take steps necessary to remove the student from the university to an appropriate setting (e.g., supervision of parents, supervision of psychiatric hospital). The University is also aware that, when a student attempts suicide, other people in the university community are affected by this act. In a residence hall this would include those students who live in the same living unit with the student who attempted suicide. Significant others, roommates, teammates and instructors are also affected by the attempted suicide of a student. The university has an interest in protecting others in the university community from the emotional stress and crisis atmosphere that accompanies attempted suicide. A student’s decision to take his or her own life is so serious that the university cannot ignore this act. In most circumstances, this decision shows that a student has emotional or mental health problems beyond the student’s immediate psychological resources. It often indicates that the student is not prepared to continue at the university in the semester in which he or she attempted suicide. Unless there is clear and convincing evidence that the student’s continuation at the university is in the student’s best interest, it is the policy of the university to administratively withdraw a student who has attempted suicide or who exhibits life-threatening behavior.

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Operating guidelines: The following are guidelines for the implementation of this policy. It is recognized that special circumstances may arise which require deviation from these guidelines, and that administrative discretion must be exercised in these circumstances. 1. Upon learning that a student is attempting suicide, the Appalachian State University Office of Public Safety and Security should be contacted. 2. Staff in the Office of Public Safety and Security will notify: a. Medical emergency personnel b. The on-call mental health professional from the Counseling and Psychological Services Center 3. Medical emergency personnel will transport a suicide attempter to the hospital. 4. A mental health professional from the Counseling and Psychological Services Center will go to the location of the student who attempted suicide and render assistance as needed. This person will contact the family of the student who attempted suicide, when appropriate, and will render support to family members and significant others at the hospital as needed. In the event the student resides off campus or the attempted suicide occurs off campus, the mental health professional from the Counseling Center will coordinate his or her activities and involvement with mental health professionals from New River Mental Health under the existing agreements with this agency. 5. Following an attempted suicide, the Office of Public Safety and Security will report the details of the incident to the administrative health officer in a timely manner. 6. The mental health professional involved will report all relevant information regarding the attempted suicide, including contacts with significant others, to the Director of the Counseling and Psychological Services Center 7. The Director of the Counseling and Psychological Services Center will provide the administrative health officer with information regarding the attempted suicide and the Director will make a recommendation to the administrative health officer. 8. The administrative health officer will make a decision based on the recommendation of the Director of the Counseling and Psychological Services Center and other relevant information as to whether the student should be allowed to continue at the university for that semester. 9. If it is decided that the student should not be allowed to remain, the administrative health officer shall administratively withdraw the student from the university using the procedure and policies established in PS 2. 10. If the decision is to let the student remain in the university, it shall be contingent on the outcome of a psychological evaluation. If the student is allowed to remain beyond that

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time, it usually will require that the student be engaged in psychotherapy. The assessment will be made by an outside licensed mental health professional. 11. In cases where a student is allowed to continue at the university, members of the Counseling and Psychological Services Center will work with other university departments to reintegrate the student into the campus environment and to develop with the student appropriate support mechanisms.

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Appendix Q: Counseling and Psychological Services Sexual Assault Protocol The actions of Counseling and Psychological Services staff may vary depending on whether they are brought in before, during, or after a student’s contact with police or emergency room personnel. Counseling Center Staff will be prepared to do the following: If the sexual assault has just occurred, make sure the victim is safe from further harm. Help her/him get someone to be with her/him, and make sure doors and windows are locked. Encourage the student to seek medical attention to assure that injuries and not-so-obvious internal injuries are treated. Medical attention is available at the emergency room at Watauga Medical Center (262-4164). Medical attention that does not involve concern for prosecution may be received within the limited hours of the Student Health Center (262-3100). If needed, the counselor will help arrange transportation (e.g. campus police, ambulance) and call the hospital in advance to inform them of preliminary information. Ask the student not to shower, clean or change clothes before making a decision about a physical examination or rape kit. Explain possible financial costs and resources for rape kit. Make sure a female counselor is made available if needed or requested. Ask the student if she or he wants the accompaniment of a friend, roommate, family member, RA or RD, significant other, female officer, etc., while keeping environmental stimuli to a minimum. Restricting the number of people in the immediate area reduces noise, distraction, and tension. Encourage the student to talk to police with jurisdiction. In the case of University Police involvement, the counselor will encourage the student to hold an informal discussion with the campus police. The purpose will be to explain legal procedures and reporting policies, without necessarily filing any formal charges. This may take place before a decision for a rape kit.

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Have as a primary concern the emotional wellbeing and support of the student, and to establish a plan for possible follow-up counseling services. Attempt to help the student regain a sense of control and make her or his own decisions (when possible). Inform the student of her or his rights and choices, and help her or him explore options. Support the student in making decisions about whom to tell and how to proceed. Explain the limits of confidentiality. Give the student the Counseling Center brochure containing information on “What Should You Do after a Sexual Assault or Rape” because the survivor’s memory may not be clear, or he or she may be in a state of shock. Give supportive others that are accompanying the student a copy of the same brochure referring to the sections entitled, “Do’s and Don’ts of Helping Sexual Assault Survivors,” and “Guidelines for Helping Someone Who Has Been Sexually Assaulted.” Assume a helping role, not an investigating role. Inform the Office of the Vice Chancellor for Student Development that a student was assaulted, if the assault was recent and in the university community, and if the alleged perpetrator was a student, without giving names. Provide crisis counseling for friends and loved ones of survivors distressed by the event. Encourage and help the survivor to resume a regular lifestyle as soon as possible. Provide follow-up counseling, supportive assistance, and/or referral, if desired.

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Appendix R: Involuntary Commitment Guidelines I. Contact Magistrate (265-5367/8) A. Provide information about the situation B. If the situation warrants further processing in the mind of the magistrate - contact New River Behavioral Healthcare (264-8759) 1. Tell New River you are calling to consult about an involuntary hospitalization and they will put you in touch with the appropriate person 2. Provide this person with the details, and they should then agree to meet you at the magistrate’s office to file paperwork II. At the Magistrate’s Office A. The magistrate will have paperwork to file as will New River B. You will sign as the petitioner C. At this time or at some time previous (the magistrate should inform you), the Sheriff’s Department, Boone Police, or University Police will be contacted to pick up the person in question and take them to the emergency room III. At the Hospital A. All parties should be represented (i.e. New River, Counseling Center) B. A physician will interview the person and also interview you as the petitioner C. The physician will make a recommendation at that time as to whether or not the person should be committed D. If so, the representative from New River will try to find a bed at one of the local psychiatric facilities (Cannon, Glenn R. Frye, or Broughton) E. Once a bed is found, the person is transported to the hospital by the police and the Counseling Center’s responsibilities end at that time.

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Appendix S: Psychological Withdrawal Handout PSYCHOLOGICAL WITHDRAWAL Questions and Answers 1.

2.

3.

Q.

What is a psychological withdrawal?

A.

A "psych" withdrawal is provided by the University Counseling Center to students whose emotional distress or substance use is so severe that they are unable to address the requirements of the academic environment. This will usually mean the student is a danger to themselves or others, is unable to adequately care for him/herself, or is engaging in excessive substance use requiring inpatient treatment or hospitalization. A student may, at the discretion of the administration of the Counseling Center, receive a psychological withdrawal if he/she has taken constructive steps to address this interference, as evidenced by participation in counseling prior to the withdrawal request, consultation with Student Health Service physicians, or other actions intended to counteract the effects of the psychological or substance use condition factors that impaired the student’s academic performance.

Q.

Can I get a "psych" withdrawal for a specific class?

A.

No. A psychological withdrawal constitutes a complete withdrawal from school. Psychological withdrawals cannot be given for selected classes.

Q.

If I get a psychological withdrawal, what will I need to do to return to school?

A.

Anyone who is granted a psychological withdrawal must remain out of school for a minimum of six months and receive treatment during that time from a licensed or certified mental health professional (e.g. psychologist, psychiatrist, counselor, social worker, or psychiatric nurse). When the student is ready to return to school they must get their therapist to send a letter to the Director of the Counseling Center documenting that they received treatment and how much (# of sessions) treatment they received. (One or two visits to a mental health professional will not suffice.) The therapist will need to make an explicit statement that (1) the student has complied with treatment; (2) the student is stable and ready to return to the unstructured, and sometimes stressful, environment of the university; (3) the student has addressed the issues that led him/her to drop out of school; and (4) it is in the best interests of the student to return to school. A diagnosis, prognosis, and recommendation for follow-up treatment should also be provided. Some students have seen a mental health professional several times soon after receiving the withdrawal and months later asked for the letter. Some of the mental health professionals are unwilling to write such a letter for someone they haven’t seen in months. It is your responsibility to work this out with your treating clinician. You must stay in treatment until the clinician will write the letter for you. You would also need to participate in a face-to-face interview with the Director or one of the Associate Directors of the Counseling Center before being re-admitted.

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4.

5.

6.

7.

8.

9.

10.

Q.

I was depressed fall semester last year and had bad grades. Could I get a psychological withdrawal for that semester?

A.

No. The Counseling Center does not give retroactive psychological withdrawals. They are only given for the current semester.

Q.

Can I stay in the residence hall if I get a psychological withdrawal?

A.

You would need to move out of your residence hall within a couple of days. Once you take a psychological withdrawal, you are no longer a student and would not be eligible for the services rendered to students (e.g. residence halls, Quinn Center, Health Center, Library, etc.)

Q.

Can I continue to get therapy/counseling or other services from the Counseling and Psychological Center after I receive a psychological withdrawal?

A.

You can receive a last termination session and referral but the Center is only able to provide ongoing services to enrolled students.

Q.

Would it show up on my transcripts?

A.

The psychological withdrawal shows up on transcripts as "W" signifying "withdrawal". Those reviewing a transcript would have no way of knowing the reason for the withdrawal.

Q.

How will a psychological withdrawal affect my financial aid or academic probation status?

A.

You would need to get that information from the source of your financial aid for the former, and from your academic advisor for the latter.

Q.

Will I be able to register for next semester’s classes during early registration?

A.

You will not be able to register for classes again until you have met the conditions of the psychological withdrawal contract listed in #3 above.

Q.

What do I need to do to get a psychological withdrawal?

A.

It is a good idea to discuss the decision with family or those who provide financial support who may also be impacted by your decision. A meeting with the Director or one of the Associate Directors who will assess whether you meet the criteria for a psychological withdrawal will be necessary.

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Appendix T: Psychological Withdrawal: Memo to Treating Professional

MEMORANDUM TO:

Mental Health Professionals Treating ASU Students who have Received a Psychological Withdrawal

FROM:

Dan Jones, Ph.D., ABPP Director, Counseling and Psychological Services Center

SUBJECT:

Documentation Required for Return to School

Anyone who is granted a Psychological Withdrawal from Appalachian State University must remain out of school for a minimum of six months and receive treatment during that time from a licensed or certified mental health professional (e.g. psychologist, psychiatrist, counselor, social worker, or psychiatric nurse). When the student is ready to return to school, I must be provided a letter documenting that they have received treatment, and how much treatment they received (# of sessions). One or two visits to a mental health professional will not suffice. The therapist will need to make an explicit statement that (1) the student has complied with treatment and is stable and ready to return to the unstructured, and sometimes stressful, environment of the university; (2) the student has addressed the issues that led him/her to drop out of school; and (3) it is in the best interest of the student to return to school. A diagnosis, prognosis, and recommendation for follow-up treatment should also be provided. If you have any questions regarding our policy, please feel free to contact me.

DJ/dnw

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Appendix U: APA Code of Ethics A copy of the APA code of ethics (12/02) is provided following this page. These guidelines reflect the primary ethical standards followed by counseling center staff.

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71

72

73

74

75

76

77

78

79

80

81

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Appendix V: Leave Request Form Name:

Leave Dates:

Leave Type:

Vacation

When Is It?

University Break

Professional Development Summer

Child Fall Semester

Have you taken measures to assure that this leave will not adversely affect others?

Comp Spring Semester Yes

No

Reason for Leave:

Staff Signature

Date

Approved by:

Director

Date

Leave Request Form Name:

Leave Dates:

Leave Type:

Vacation

When Is It?

University Break

Professional Development Summer

Child Fall Semester

Have you taken measures to assure that this leave will not adversely affect others? Reason for Leave:

Staff Signature

Date

Approved by:

Director

Date

Comp Spring Semester Yes

No

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Appendix W: Position Descriptions -- Responsibilities and Activities The following lists the general responsibilities, activities and expectations of each of the positions at the ASU Counseling Center. Director The Director of the Counseling and Psychological Services Center is ultimately responsible for all activities of the Center and Wellness Center including: 1. Counseling Center Information 2. Clinical Services 3. Groups Program 4. Outreach 5. Consultation 6. Training 7. Brochure Development 8. Office Functions 9. Wellness Center/Stress Management 10. Alcohol and Drug Assistance Program 11. Peer Career 12. Crisis Services 13. Suicide Prevention 14. Biofeedback 15. Psychological Withdrawal System 16. Faculty Consultation 17. Rape/Sexual Assault Prevention 18. Development of Policies and Procedures 19. Staff Evaluations 20. Center Effectiveness Research and Monitoring of Accountability 21. Hiring Personnel, Handling Promotions, Grievances, etc. 22. Budget Management 23. Public Relations 24. Administrative Report Writing 25. Physical and Office Management of the Center 26. Uncle Sigmund Advising Service 27. Parent Orientation 28. Representation in National Organizations 29. Teaching 30. University Committee Work.

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Associate Directors 1. Administration and supervision of the entire Center in the Director' s absence. 2. Evaluation of students for psychological withdrawals, readmission following psychological withdrawal and release from ASU Housing Contracts. 3. Miscellaneous administrative tasks as needed. Director of Training 1. Suggests training policy for review by the staff of the Center. The Training Director remains responsible for all final policy decisions. 2. Coordinates training activities (including seminars, group supervision, etc.) and evaluations. 3. Integrates input from training staff and other professionals to develop and modify the training program. 4. Reviews and recommends training procedures and oversees their implementation. 5. Arranges all supervisory assignments and coordinates the Center staff to fill a variety of training roles. 6. Coordinates the supervisory evaluation and feedback process. 7. Coordinates intern/practicum application and selection process and maintains liaisons with appropriate faculty from the students'academic programs. 8. Serves as liaison between trainees and staff, providing feedback, processing grievances, etc. Clinical Director 1. Monitors Center and staff compliance with clinical policies and procedures. 2. Assumes accountability for clinical services. 3. Coordinates development and revision of forms used in the Center. 4. Manages the Counseling Center database. 5. Reports statistics and other information concerning Counseling Center clients. 6. Disseminates current information on legal and ethical issues relevant to delivery of clinical services. 7. Oversees crisis management procedures for emergencies within the Counseling Center. Develops on-call schedule and shares this information with appropriate university agencies. 8. Coordinates clinical procedures/contacts between the University community and other local mental health agencies. 9. Maintains updated resource and referral information. 10. Monitors Individual Counseling List and oversees assignment of clients to counselors. 11. Monitors staff caseloads. 12. Coordinates peer review process of clients requiring counseling beyond 10-session limit. Outreach and Consultation Coordinator 1. Serves as an educational resource person to disseminate general information about mental health issues to the university community upon request.

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2. 3. 4. 5. 6.

7. 8. 9.

Provides students, staff, and faculty with information about the Counseling Center services and resources. Coordinates staff development activities. Monitors requests for professional consultation by other university employees. Is the agency representative to respond to requests from the university community for programs, workshops, or presentations. Collects relevant and timely information from consultees and/or program recipients regarding adequacy of services provided, performance of the Counseling Center staff member providing the service, and recommendations for improvement. Develops and evaluates the adequacy of formal written procedures to monitor requests for consultative services and programming. Develops and evaluates the adequacy of other record keeping and evaluation forms related to consultation, outreach, and programming. Cooperates with other Coordinators and the Counseling Center Director in the overlap of responsibilities and in emergency situations.

Master’s-Level Training Coordinator 1. Co-teach a one-hour per week seminar that covers skills in counseling and case presentations, provides group supervision, and includes special topic areas such as ethics and referral sources. 2. Coordinate individual supervision for the practicum and extern students. 3. Expose students to Counseling Center staff and procedures. 4. Inform practicum and extern students about significant changes, events, and concerns. 5. Coordinate procedures for obtaining volunteer clients. 6. Oversees clinical documentation in client files Groups Coordinator 1. Coordinates with the clinical staff the types and schedules of therapy groups to be offered each semester. 2. Oversees advertising and dispersal of information about groups to the university community. 3. Responds to requests for information from university students, faculty and staff. 4. Keeps staff informed about status of group activity in the Center. 5. Responds to requests for group services/information from faculty or students when related to a course experience. Peer Career Coordinator 1. Organization of Peer Career operation and activities. 2. Decision-making regarding service delivery, selection, training, publicity, etc. 3. Providing of training. 4. Facilitating staff meetings. 5. Supervision of counselors, assistants, work study students, interns and practicum students.

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6. 7. 8. 9. 10. 11. 12.

Maintenance of contact with ASU offices and companies supplying resources. Liaison with the Counseling Center and Career Development Center. Compilation of the annual report. Consultation with instructors, advisors, counselors, etc. Evaluation of services. Service delivery when counselors are occupied. Miscellaneous administrative decisions and tasks.

Research Coordinator 1. Monitors all research activities taking place in the Counseling Center to ensure that both services to clients and staff members’ investment in research projects remain high. 2. Coordinates the Research Committee, the purpose of which is to generate enthusiasm for research, provide a forum for discussing current staff research projects, and consultation about proposed research projects in the Counseling Center. 3. Screens requests for research at the Counseling Center originating from outside the Center (e.g. ASU master’s students, faculty from other departments, and researchers at other universities). Consults with Director and Research Committee about whether certain research projects should be considered further. 4.

Facilitates the use of data routinely collected at the Counseling Center (e.g. OQ-45 and Wellness Check) to answer research questions that may arise from the staff.

5.

Monitors data files of routine client information that exist separate of the Protégé database (e.g. Wellness Check data entered in SPSS).

Wellness Program Coordinator 1. Provides leadership in directing the Wellness Center. 2. Administers the Wellness Center as a resource, education, and training center. 3. Individual and group counseling on wellness issues. 4. Referral to other campus and community services as needed. 5. Supervision of Wellness Peer Education Program including supervision of graduate interns, recruiting, training, on-going supervision, and development of new programs. 6. Supervision of Wellness Center Office staff including secretary and student employees. 7. Consultation with other faculty, staff, and students in developing comprehensive health promotion, stress management, and wellness programs. 8. Planning, supervision, and implementation of campus health fairs, mini-health fair, and national observances such as Great American Smokeout. 9. Development of budget requests for Wellness Center Operation 10. Maintenance of educational resources. 11. Continuing development of biofeedback and stress management program. 12. Supervision and training of student trainees in practicum and internship. 13. Coordination of Uncle Sigmund, an electronic information and referral service.

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14. Coordination of Wellness Center activities with Counseling Center, Alcohol and Drug Assistance Program, and other campus resources. 15. Work with various agencies in writing proposals for internal and external funding. Alcohol and Drug Assistance Program Coordinator 1. Individual and group counseling for substance abuse, mental health and wellness concerns. 2. Assessment, treatment, group support, consultation and referral for substance abuse and wellness concerns. 3. Supervision and co-coordination of Wellness peer education program, including graduate counselors and student-temporary instructors. 4. Supervision and training of trainees with substance abuse specialization. 5. Provides wellness education/outreach programming and related special events for the campus community.

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Appendix X: Annual Performance Review APPALACHIAN STATE UNIVERSITY COUNSELING AND PSYCHOLOGICAL SERVICES CENTER ANNUAL PERFORMANCE REVIEW

Date of Review_______________________

Name: Position Title:___________________________________________________________ Review Period: From_____________________ To_____________________________ Employment Date:________________________

The following scale is used to evaluate each area of job performance: 1. 2. 3. 4. 5.

Far exceeds normal expectations for this performance area. Above expected levels of performance in this area. Consistently meets expected levels of performance in this area. Generally meets expectations, but needs improvement in this performance area. Does not meet expectations for this performance area.

The contents of this performance review have been discussed with this employee. _______________________ _________________________ ______________________ Date Signature of Employee Signature of Supervisor

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1. 2. 3. 4. 5. I.

Far exceeds normal expectations for this performance area. Above expected levels of performance in this area. Consistently meets expected levels of performance in this area. Generally meets expectations, but needs improvement in this performance area. Does not meet expectations for this performance area. Administrative: Goal: Contribute to and assume individual responsibility for maintenance of and planning for a specific area of service within the Counseling Center. Area of Responsibility:______________________________________________ Standards: 1. Attend and actively participate in weekly agency activities (e.g. staff meetings, case review, etc.) 1

2

3

4

5

2. Undertake special assignments as negotiated with Director. 1

2

3

4

5

3. Provide leadership in assigned administrative area (planning, implementation, policies and procedures, staff training, consultation, etc.). 1

2

3

4

5

4. Arrange coverage of clinical and other duties when needed due to absence. 1

2

3

4

5

5. Understand and attend to larger system (big picture) issues such as public relations, staff morale, and legal and ethical issues. 1

2

3

4

5

6. Keep Director informed of events that could have public relations, political, or risk management implications. 1

2

3

4

5

Personal Goal:______________________________________________________ __________________________________________________________________

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1. 2. 3. 4. 5. II.

Far exceeds normal expectations for this performance area. Above expected levels of performance in this area. Consistently meets expected levels of performance in this area. Generally meets expectations, but needs improvement in this performance area. Does not meet expectations for this performance area. Clinical: Goal: Provide high quality and ethical clinical services in a variety of situations. (Depending on job description, staff members may have different clinical responsibilities.) Standards: 1. Produce timely and appropriate written reports of student clinical contacts. 1

2

3

4

5

2. Seek consultation from other staff as clinically appropriate, especially in life threatening situations or when deviating from usual protocols, policies, or procedures. 1

2

3

4

5

3. Provide crisis intervention for clinical emergencies in a timely and appropriate manner, consult as needed, provide referrals, and keep other involved professionals informed within legal and ethical limits. 1

2

3

4

5

4. Adhere to the Policies and Procedures Manual regarding clinical services including legal and ethical guidelines. 1

2

3

4

5

5. Demonstrate awareness and application of counseling skills related to diversity when appropriate. 1

2

3

4

5

Personal Goal:______________________________________________________ __________________________________________________________________

92

1. 2. 3. 4. 5. III.

Far exceeds normal expectations for this performance area. Above expected levels of performance in this area. Consistently meets expected levels of performance in this area. Generally meets expectations, but needs improvement in this performance area. Does not meet expectations for this performance area. Training and Supervision Goal: Contribute to the training and supervision of interns and practicum students. Standards: 1. Provide quality supervision sessions as assigned for professional training. 1

2

3

4

5

2. Complete supervision notes, supervision consultant contracts, evaluations, and reference letters in a timely fashion. 1

2

3

4

5

3

4

5

3. Elicit feedback from supervisees. 1

2

4. Monitor supervisee’s activities and ensure welfare of clients served by supervisees. 1

2

3

4

5

5. Participate in training committee meetings and, as needed, training activities such as selection, self-study, and grievance hearings. 1

2

3

4

5

6. Conduct and document assigned training seminars and case presentations. 1

2

3

4

5

Personal Goal: ______________________________________________________ __________________________________________________________________ __________________________________________________________________

93

1. 2. 3. 4. 5.

IV.

Far exceeds normal expectations for this performance area. Above expected levels of performance in this area. Consistently meets expected levels of performance in this area. Generally meets expectations, but needs improvement in this performance area. Does not meet expectations for this performance area.

Outreach Services Goal: Plan and deliver high quality outreach programs and workshops, professional development, and in-service programs as needed and negotiated. Standards: 1. Maintain regular communication with Director of Outreach regarding programming requests and needs. 1

2

3

4

5

2. Complete appropriate administrative tasks associated with outreach activities (e.g. workshop preparation, report forms, evaluations, etc.). 1

2

3

4

5

3. Participate in divisional or university public relations activities (e.g. Student Development Professional Development meetings, orientation programs, Walk for Awareness, “Sex and a Six Pack,” etc. 1

2

3

4

5

4

5

4. Present outreach programs and workshops. 1

2

3

5. Establish an effective consultatory relationship with assigned liaison group, e.g. residence life communities, athletics, international students, etc. 1

2

3

4

5

Personal Goal:______________________________________________________ __________________________________________________________________

94

1. 2. 3. 4. 5. V.

Far exceeds normal expectations for this performance area. Above expected levels of performance in this area. Consistently meets expected levels of performance in this area. Generally meets expectations, but needs improvement in this performance area. Does not meet expectations for this performance area. Professional Development Goal: To continue professional growth and meet requirements for licensure and other professional certifications. Standards: 1. Demonstrate an appreciation for the impact of human diversity on her/his professional practices by attending relevant campus activities, participating actively in staff discussions of the topic, and providing effective multicultural supervision to trainees. 1

2

3

4

5

2. Demonstrate ethical professional behavior including knowledge of relevant professional ethical standards, legal statutes, and appropriate consultation with peers and supervisors. 1

2

3

4

5

Personal Goal:______________________________________________________ __________________________________________________________________ __________________________________________________________________

95

1. 2. 3. 4. 5.

VI.

Far exceeds normal expectations for this performance area. Above expected levels of performance in this area. Consistently meets expected levels of performance in this area. Generally meets expectations, but needs improvement in this performance area. Does not meet expectations for this performance area.

Teamwork Goal: Maintain a work environment that fosters open communication, strong working relationships, and the smooth operation of Counseling Center activities. Standards: 1. Work collaboratively with other staff members. 1

2

3

4

5

2. Address conflict directly with other staff members (includes appropriate use of others as consultants). 1

2

3

4

5

3. Participate in coverage of tasks as needed (e.g. front office, emergencies, outreach and consultation). 1

2

3

4

5

4. Complete tasks on time and make promised arrangements. 1

2

3

4

5

5. Check with Director about leave/vacation time and consider needs of center, students, and other staff in scheduling leave/vacation time. 1

2

3

4

5

Personal Goal:______________________________________________________ __________________________________________________________________ __________________________________________________________________

96

ADDITIONAL COMMENTS: