Counseling Scope of Practice and Services

The Counseling and Psychological Services (CAPS) promotes the psychological well-being and personal achievement and growth of Eastern students. CAPS services are provided at no charge to undergraduate and graduate students registered for the semester in which they are seeking services. The Center offers individual and group counseling, crisis intervention, psychiatric evaluations and medication management. The Center provides consultation to faculty and staff regarding any questions or concerns about students. In addition, the Center conducts outreach services for the University’s community which include presentations/trainings on a variety of topics related to college-based mental health issues and student development.

Scope of Practice

CAPS Services are provided by licensed mental health staff or direct supervisees, within an appropriate scope of practice, meaning delivering services consistent with level of training, experience, and competence. Services are also provided to clients appropriate for outpatient mental health services, while enrolled students at Eastern CT State University. If it is determined that a client requires services outside of CAPS scope of practice, staff will assist with finding an appropriate referral.

Examples of issues that could be addressed by a community referral include but are not limited to:

• Individuals with chronic mental health conditions that require longer-term, ongoing care.
• Clinical presentations, such as some personality disorders, that indicate short-term therapy may be ineffective and/or detrimental.
• A need to be seen more frequently than CAPS can accommodate (beyond 2-4 times per month).
• Excessive utilization of urgent services indicates standard session frequency is inadequate.
• Chronic suicidality and/or recent history of multiple suicide attempts.
• Severe and chronic self-injury.
• A history of multiple psychiatric hospitalizations.
• Issues that require more specialized care than can be provided at CAPS, including:
  • Significant or chronic disordered eating symptoms posing medical danger
  • Significant or chronic substance use/abuse which compromises therapy
  • Active symptoms of psychosis at risk for progressive deterioration

CAPS may decline services and/or refer individuals to community resources due to:

• Lack of motivation or engagement in treatment, as evidenced by:
• Unwillingness to provide information sufficient for clinical assessment
• Inability to identify treatment goal(s) appropriate for therapy
• Inconsistent attendance
• Poor compliance with treatment recommendations
• Non-compliance w/treatment recommendations during multiple crisis intervention sessions
• Ongoing treatment relationship with another mental health provider
• Inappropriate, harassing, menacing, threatening, or violent behaviors
• Mandated or required treatment, including but not limited to:
  • Counseling ordered through legal proceedings, such as substance abuse treatment, alcohol education, anger management, parenting education, or domestic violence treatment
  • Counseling required by employers, government agencies, academic departments, or classes
  • Comprehensive psychological evaluation of any type, including but not limited to:
  • Neuropsychological evaluations
  • Forensic assessments (including Assessment and documentation for service or support animals)
  • Custody evaluations
  • State/Federal benefit programs, including vocational rehabilitation and social security/disability
  • Fitness-for-duty evaluations
  • Pre-surgical mental health evaluations
  • Medication-management-only treatment plans, including following termination of short-term psychotherapy

Other situations that are determined to be outside the scope of services provided by CAPS, or in which case a clinical staff member determines that treatment would be detrimental to the client or to the proper functioning of the department.

Referral Criteria

Criteria for referral should be clearly defined in client’s file through professional documentation, and should typically include:

• DSM-5 Diagnosis
• Presenting concerns (include symptomology), impact on social, occupational/academic functioning
• At risk behaviors/concerns including:
  • SI/HI, plan, intent, attempts, moderate/severe substance Use, NSSI/SIB, Prior Hospitalizations/IOP
• Psychiatric history/Psychotropic medication (prescribed by/how long, etc.)
• Ability to access community resources including:
  • Insurance, Financial resources (ability to pay co-pays, deductibles, or self-pay), Transportation, Anonymity (parents), Ability to engage in community services
• Reason for referral (include clinical formulation)
  • Client needs are beyond scope of practice for all CAPS clinicians because
  • Client requires higher level of care due to
  • Client would benefit from services more than once/week because
  • Granted MLOA

Possible Exceptions to Exclusionary Criteria

Occasionally, CAPS clinicians may extend services, beyond circumstances defined above. Circumstances which may warrant such services include but are not limited to:

• Coverage through upcoming graduation within the semester.
• Completion of treatment for clients making good progress but needing limited extension of services.
• Supporting high-functioning clients with chronic conditions on well-defined short-term goals.
• Longer-term therapy for committed and progressing clients comprising 5% or less of any clinician’s caseload, for training and diversity.

When a client’s circumstances represent a possible exception to exclusionary criteria, the clinician must present the case to CAPS clinical staff for consultation and approval.