Checklists for Colleges and Counseling Centers

Counseling Service Checklist

-What is the make-up of your staff and how does it fit with the demographics and needs of the student population? Do you have prescribers and clinicians with sensitivity to the diversity of your student body?

- What data do you track and how do you manage the triage function, sorting out who needs to be seen today versus sometime soon? Harvard has implemented a triage program borrowed from the University of Massachusetts in Amherst. We have brief phone intakes available every day with senior clinicians to determine if someone needs to be seen immediately, whether that student needs to see a prescriber, someone with eating disorder expertise, and so on. This process has had a major, positive influence on both students and staff.

- Do you have a good scheduling system to manage your resources? Our system automatically sends out e-mail reminders of appointments forty-eight hours in advance. We have dropped our no-show rate from 15 percent down to 7 percent, which translates into about seventeen hundred additional available visits for students. Knowing seasonal demand and having adequate staff is crucial. Central scheduling and referral must be present in all but the smallest counseling services. Scheduling must be done centrally to address the ebb and flow of community needs. If individual clinicians keep their schedules independently, they will not be able to see the big picture needs of the community.

-What is your scope of service? Providing a consultative, educational function for the college community maximizes your effectiveness and value to the college. This would often include

1. Training and ongoing consultation for residential staff
2. Programs to destigmatize mental health problems on campus
3. Active participation in work groups dealing with alcohol and other common campus health problems
4. Support for administrative faculty and staff to help ­ recognize problems, make referrals, and address complex emotional problems seen in the classroom setting
5.  Focus on wellness activities: stress management skills, sleep hygiene, tolerance, and celebration of diversity

-How are decisions made regarding resource utilization? It is probably pretty consistent that 10 to 25 percent of students will access services with appropriate outreach. We know that a small percentage of those will have serious resource-demanding mental illnesses, some will come in once or twice for brief help with a crisis, and some will come in to work on developmental or personal problems. Decisions must be made on how best to allocate available resources to serve the needs of the community.

- What roles do students play in your service? Do you sponsor peer-counseling groups, student health advisory groups, or residential supports or education? Hearing from your primary consumers is very important.

- What are the standards of care for psychotherapy for your discipline in your community? Your documentation should meet or exceed these standards. There should be standardized assessment questions during initial evaluations so that students are receiving consistent care across clinicians and disciplines. Visits must be documented with clear mental status assessment if you are providing psychotherapy.

- What efforts are in place for quality improvement? Are there regular satisfaction surveys and metrics to measure available access and follow-up times?

- Is regular staff training available to develop new skills and expand skills in common problem areas such as alcohol, eating disorders, or sleep problems?

- What is the center's role with academic or disciplinary problems? Is there mandated assessment or treatment?

- What is the interface with the disability officer and re­ sources for testing?

- Do you have a group program? Although often difficult to start, groups are very cost- and clinically effective programs for many problems. Students find them extremely helpful once they cross the threshold to join a group. 

-Do you have contact and outreach to international students and students from different cultures who may feel isolated or have difficulty accepting or accessing mental health care?

- Do you have a robust Web site that describes services and provides on-line screenings and health information? Do clinicians communicate with clients via e-mail? Many students on many campuses do much of their communicating over the Web.

- What information comes to the school from pre-registration medical forms? Are there mental health questions on those forms? Is any prescreening done? What screening programs take place during the year?

- Do you serve special populations, such as athletic teams, graduate students, multicultural groups, and fraternities? What are the unique needs of these groups?

- What kind of educational programming and discussion groups do you provide for students? These might focus on topics such as academic support, stress management, and sleep hygiene to name a few.

- How do you track referrals and follow-up? You should have a central tracking system that might include an electronic bulletin board, voice mail, or other method for keeping staff up-to-date on worrisome, high-risk students. It is very important to track referrals and follow up. We have just started sending a satisfaction survey to referred students to see what their experience is.

- What is your crisis management and referral process? This is last, but not least. There should be clear systems of communication when students have off-hours crises. There should also be a plan in place for students who may not require hospitalization but are also not appropriate for a dormitory setting. Many college infirmaries have closed down because they are expensive to run, but there should be contingency plans for situations like this and good working relationships with local emergency rooms, including careful handoffs. When students are hospitalized, there should be a clear reentry process. And when students take a medical leave (a good policy to have), it is important to screen students to determine their readiness to return to school.