CPSC Counseling Center Village

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					      Appalachian State University
Counseling & Psychological Services Center




                 Policies
                    &
                Procedures




               August, 2004
                                                    TABLE OF CONTENTS

Eligibility for Services..............................................................................................        1
        Summer Session ...........................................................................................            1
        Minors ...........................................................................................................    1
        Spouses and Family......................................................................................              2

Intake and Scheduling Procedures .........................................................................                    2
       Walk-In Clinic ..............................................................................................          2
       Assigning Clients ..........................................................................................           3
       Scheduling On-going Clients.......................................................................                     4
       Treatment Guidelines ..................................................................................                4
       No Show Policy…………………………………………………………….                                                                                 5
       Follow-up from Walk-Ins ............................................................................                   5

Clinical Documentation-Protégé and Paperwork .................................................                                5
       Dealing with Old Client Files ......................................................................                   7
       Creating Files for Potential Clients ............................................................                      8
       Clinical Note Content—PIP System ...........................................................                           8
       File Storage ...................................................................................................       9
       Release of Information ................................................................................                9
       Evaluations of Clinical Services ..................................................................                   10

Clinical Services: Limits and Review .....................................................................                   10
       Individual Therapy and Peer Review Process...........................................                                 10
       Changing Counselors ...................................................................................               10
       Group Therapy.............................................................................................            11
              Group Referrals .................................................................................              11
              Co-leaders/Interns .............................................................................               12
              Group Notes .......................................................................................            12
       Psychiatric Consultation .............................................................................                12
       Court Referrals ............................................................................................          14
       Clients with Attention Deficit Disorder .....................................................                         14
       Campus Health Service ...............................................................................                 15
       Testing ...........................................................................................................   15
       Student Wellness Center .............................................................................                 16
              Peer Outreach Programs ...................................................................                     16
              Biofeedback ........................................................................................           16
              Substance Abuse.................................................................................               17
       Peer Career ...................................................................................................       17
       Individual Counseling List ..........................................................................                 17
       Single Sessions During Final Week ............................................................                        18
                                                                                                                                 ii


Emergency Procedures: At-Risk Clients ...............................................................                       19
     On-Call/Emergency Procedures .................................................................                         19
     Emergency Meetings with Clients in Crisis ...............................................                              21
            Counseling Center .............................................................................                 21
            The Infirmary .....................................................................................             21
            Watauga Medical Center Emergency Room ......................................                                    21
            University Police ................................................................................              22
     Volatile Clients .............................................................................................         22
     Suicide Attempts/Gestures-Notification of Parents ..................................                                   22
     Sexual Assault...............................................................................................          23
     Hospitalization..............................................................................................          23
     Psychological Withdrawals .........................................................................                    24
     Situations Requiring Notification of the Director/Assoc. Director .........                                            25

Common Ethical Concerns .....................................................................................               25
    Dual Relationships .......................................................................................              25
    Therapist-Trainee Clients ...........................................................................                   26

Outreach and Consultation .....................................................................................             26
      Processing Requests .....................................................................................             26
      Bulletin Boards .............................................................................................         27
      Residence Life Consultants .........................................................................                  27
      Uncle Sigmund .............................................................................................           27
             Uncle Sigmund Advisor......................................................................                    28
             Guidelines for Uncle Sigmund Responses .........................................                               28
             Accessing Uncle Sigmund ..................................................................                     29

Staff Expectations ....................................................................................................     29
       Schedules.......................................................................................................     30
       Leave ............................................................................................................   30
       Adjunct Staff ................................................................................................       30
       Private Practice ............................................................................................        31
       Position Responsibilities ..............................................................................             31
       Professional Development ...........................................................................                 32
       Teaching ........................................................................................................    32
       Licensing .......................................................................................................    32
       Supervision ...................................................................................................      33
       Administrative Support ...............................................................................               33
       Front Desk ....................................................................................................      33
       Meetings ........................................................................................................    33
              Staff Meeting ......................................................................................          33
              Peer Supervision ................................................................................             34
              Psychiatric Consultation....................................................................                  35
       Committees ...................................................................................................       35
       Annual Performance Review ......................................................................                     35
                                                                                                                                 iii


Training     ............................................................................................................   35
      Practicum ......................................................................................................      35
      Master’s Level Externship ..........................................................................                  36
      Pre-doctoral Internship ...............................................................................               36


APPENDICES ..........................................................................................................       37
     Appendix A: Mission Statement .................................................................                        38
     Appendix B: Severity Rating Descriptors..................................................                              39
     Appendix C: WIC Procedures Checklist ..................................................                                40
     Appendix D: Treatment Guidelines ...........................................................                           41
     Appendix E: Walk-In Flow Chart ..............................................................                          43
     Appendix F: Policy on Release of Counseling Center Records ...............                                             44
     Appendix G: Individual Counseling Feedback .........................................                                   45
     Appendix H: Session Extension Request Form for Peer Review ............                                                47
     Appendix I: Psychiatric Referral Criteria .................................................                            49
          Request for Consultation for Counseling Center Client ..............                                              51
     Appendix J: Authorization to Release Information ……………………                                                              52
     Appendix K: Single Assessment Report ....................................................                              53
     Appendix L: Career “Prescription” ...........................................................                          54
     Appendix M: Individual Counseling Information ....................................                                     55
     Appendix N: Counseling Center Emergency Services .............................                                         56
     Appendix O: Volatile Clients-Safety Procedures ......................................                                  57
     Appendix P: University Policy on Suicidal/Dangerous Behavior ............                                              59
     Appendix Q: Sexual Assault Protocol ........................................................                           62
     Appendix R: Involuntary Commitment Guidelines .................................                                        64
     Appendix S: Psychological Withdrawal Handout ....................................                                      65
     Appendix T: Psychological Withdrawal: Memo to Treating Professional                                                    67
     Appendix U: APA Code of Ethics...............................................................                          68
     Appendix V: Leave Request Form ……………………………………….                                                                        83
     Appendix W: Position Descriptions—Responsibilities and Activities ....                                                 84
     Appendix X: Annual Performance Review ...............................................                                  89
                         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 non-
student 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
                                                                                                        4


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 up-
to-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 follow-
up.


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.
                                                                                                    6


     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.
                                                                                                       9


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.
                                                                                                     12


     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/follow-
up 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.
                                                                                                      13


     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.
                                                                                                    14


     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
                                                                                                   15


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
                                                                                                     16


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
                                                                                                       17


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 self-
assessment, 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 up-
to-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
                                                                                                       18


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
                                                                                                        19


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 cell-
phone, 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
                                                                                                    20


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.
                                                                                                     21


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.
                                                                                                      22


     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.
                                                                                                     23


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.
                                                                                                    24


     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.
                                                                                                      25


     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
                                                                                                    26


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
                                                                                                     27


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
                                                                                                   28


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
                                                                                                   29


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 user-
friendly 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.
                                                                                                    30


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
                                                                                                    31


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 part-
time 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
                                                                                                        32


     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.
                                                                                                   33


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
                                                                                                    34


        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.
                                                                                                     35


       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.
                                                                                                36


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.
             37




APPENDICES
                                                                                              38


                               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.
                                                                                                   39


                           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.
                                                                                                  41


                               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
                                                                                                    42


   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.
                                                                              43


                        Appendix E: Walk - In Flow Chart


                       Client Referred to Group or
                     Individual Therapist From WIC




           Client shows for
                                               Client No Shows or
          First Appointment
                                                Cancels without
                                                  Re-scheduling



   Therapist Decides on Follow –             Therapist Sends Note
     up For Subsequent No -                   to WIC Counselor
     Shows Or Cancellations                    Who Decides …




       Follow No-Show                                  Make Personal
            Policy                                    Phone Call (Client
                                                       May be at Risk)




                  Replace Client at                              Reschedule, Refer
Terminate if         Bottom of                 Terminate
                                                                  or Make Other
No Contact            Individual                                   Arrangements
 within 48        Counseling List if
   hours            they contact
                  Center within 48
                        hours
                                                                                                 44


       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.
                                                                                                                 45


                                                              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                                                                                 Very Poor
          1                   2               3                4              5          6             7

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

          Strongly Agree                                                                     Strongly Disagree
          1                   2               3                4              5          6               7

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

          Strongly Agree                                                                     Strongly Disagree
          1                   2               3                4              5          6               7

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

          Strongly Agree                                                                     Strongly Disagree
          1                   2               3                4              5          6               7

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

          Strongly Agree                                                                   Strongly Disagree
          1                   2               3                4              5          6             7

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

          Strongly Agree                                                                     Strongly Disagree
          1                   2               3                4              5          6               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                                                                    Very Unsuccessful
          1               2                   3                4              5          6             7

8) Do you think the services you received at the Counseling Center have contributed to:
      Your remaining at Appalachian State?                       YES_____ NO_____           N/A_____
      A greater ability to study and concentrate?                YES_____ NO_____           N/A_____
      Improved academic performance?                             YES_____ NO_____           N/A_____
      Increased class attendance?                                YES_____ NO_____           N/A_____
      Your becoming more involved at Appalachian?                YES_____ NO_____           N/A_____
                                                                                                           46



 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?




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                                                                                      Very Poor
1                  2               3               4               5               6              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                                                                                      Very Poor
1                  2               3               4               5               6              7

 Any comments about this experience?




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




                          Name (optional): __________________________________________

   Thank you very much for your time and consideration in helping us to evaluate/improve our Center!
                                                                                                 47


               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?
                                                                                      48




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________________________
____________________________________
____________________________________
                                                                                                  49


                           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
                                                                                                50


    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.
                                                                                         51


                     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          Therapist/Group: ___________________________________

   _____ Individual Therapy         Therapist: __________________________________

   _____ Wellness Center  Therapist: _________________________________


Service Requested:

_______ Diagnostic Evaluation           _______ Medication Evaluation         _______
Dietician Session

Referral Question(s):




Specific Symptoms & Known Medications:




Additional Comments:
                                                                                         52


                                      Appendix J
            CONSENT TO RELEASE INFORMATION

Student Health Services                                   Counseling and
                                                      Psychological Services

I,                                      , 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:                                               Date:
                        Patient

                                                      Date:
              Witness



                             REFERRAL INFORMATION




                                                              Date:
              Referring Clinician
                                                                                         53




                          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:
                                                                                                54


                                          Appendix L

                                     Career “Prescription”

Self-Assessment Resources

Please allow                                                  to utilize the following Peer Career
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                              O*NET                                 CPPlus
       CIN                                   Experience On Line                    Books
       Internet


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:______________________
                                                                                                     55



                                            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
                                                                                                 56




        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
                                                                                                    57




                       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
                                                                                                   58


   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.
                                                                                                     59


               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.
                                                                                                    60


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
                                                                                        61


    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.
                                                                                                 62


                     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.
                                                                                                63


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.
                                                                                                    64



                      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.
                                                                                                    65


                  Appendix S: Psychological Withdrawal Handout

                        PSYCHOLOGICAL WITHDRAWAL
                             Questions and Answers

1.   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.


2.   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.


3.   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.
                                                                                                        66

4.    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.


5.    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.)


6.    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.


7.    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.


8.    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.


9.    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.


10.    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.
                                                                                                  67


          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
                                                                                          68


                              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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                                                                                                        83


                                    Appendix V: Leave Request Form

Name:                                                          Leave Dates:

Leave Type:         Vacation           Professional Development               Child   Comp

When Is It?         University Break            Summer              Fall Semester     Spring Semester

Have you taken measures to assure that this leave will not adversely affect others?   Yes     No

Reason for Leave:




Staff Signature                                                         Date


Approved by:



Director                                                                Date


                                             Leave Request Form

Name:                                                          Leave Dates:

Leave Type:         Vacation           Professional Development               Child   Comp

When Is It?         University Break            Summer              Fall Semester     Spring Semester

Have you taken measures to assure that this leave will not adversely affect others?   Yes     No

Reason for Leave:




Staff Signature                                                         Date

Approved by:



Director                                                                Date
                                                                                                                84



              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.
                                                                                                        85

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.
                                                                                                         86

    2.   Provides students, staff, and faculty with information about the Counseling Center services and
         resources.
    3.   Coordinates staff development activities.
    4.   Monitors requests for professional consultation by other university employees.
    5.   Is the agency representative to respond to requests from the university community for programs,
         workshops, or presentations.
    6.   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.
    7.   Develops and evaluates the adequacy of formal written procedures to monitor requests for
         consultative services and programming.
    8.   Develops and evaluates the adequacy of other record keeping and evaluation forms related to
         consultation, outreach, and programming.
    9.   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.
                                                                                                               87

   6.     Maintenance of contact with ASU offices and companies supplying resources.
   7.     Liaison with the Counseling Center and Career Development Center.
   8.     Compilation of the annual report.
   9.     Consultation with instructors, advisors, counselors, etc.
   10.    Evaluation of services.
   11.    Service delivery when counselors are occupied.
   12.    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.
                                                                                                   88

   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.
                                                                                     89



                         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.   Far exceeds normal expectations for this performance area.
2.   Above expected levels of performance in this area.
3.   Consistently meets expected levels of performance in this area.
4.   Generally meets expectations, but needs improvement in this performance area.
5.   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
                                                                                                    90



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

I.      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:______________________________________________________

        __________________________________________________________________
                                                                                                   91



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

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


III.      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. Elicit feedback from supervisees.

                 1              2                3             4              5

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



IV.      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. Present outreach programs and workshops.

                1              2               3              4              5

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


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



VI.      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




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