Scope of Service and Eligibility

Scope of Service Statement

Current as of 9/16/2022

Counseling Services supports and promotes the mental health of Caltech students in order to improve the quality of their lives and aid them in achieving academic success. We are proud to support large numbers of Caltech students: In the 2021/22 academic year, we saw 23.2% of enrolled students - our highest utilization ever. Because we see so many students each year, Counseling Services has to balance two important needs: To provide rapid access for students throughout the year (breadth), and to provide appropriate care for students' concerns (depth). This Scope of Service Statement, then, is our effort to communicate our thinking about how we balance the breadth and depth of our services through a short-term goal-oriented model of counseling.

These two needs - breadth and depth - influence each other in complex ways. For instance, offering many appointment slots for new students each week will reduce waiting times, but leaves fewer appointments for returning students who need ongoing care. Likewise, offering long-term counseling to many students means that there are fewer openings for new students, which becomes an equity issue. While we do not hold to rigid session limits, we do need to keep a short-term, goal-oriented focus. Practically, this means that most students usually meet with us for 6-8 sessions. Given our short-term focus, then, we must be thoughtful and use our clinical judgment about how to best meet each student's emotional and mental health needs, whether in our office, elsewhere on campus, or in the community.

To accomplish this, we talk with students in the first 1-2 meetings about setting a specific goal for therapy, and make a treatment recommendation. We know from research that different problems often require different approaches and different amounts of time to address. For instance, a student presenting with situational stress will probably need less time to get back to their baseline than a student presenting with, say, a chronic eating disorder.

For students whom we work with in-house, we work collaboratively to set realistic goals that can be accomplished in a reasonable amount of time - again, usually in the 6-8 session range. We check in regularly about progress and if the student's goals are being met, using both subjective judgments and objective changes on assessment measures such as the CCAPS (Counseling Center Assessment of Psychological Symptoms) questionnaire.

When a students' goals require services that we do not offer, or when their needs go beyond our short-term, goal-oriented treatment model, we will work with our referral coordinator to connect the student with appropriate community resources.

Concerns that we commonly treat at Counseling Services include, but are not limited to:

• Relationship problems with family, friends, advisors, or romantic partners
• Most anxiety disorders, including panic disorder, social anxiety, and generalized anxiety
• Stress management
• Procrastination and avoidance
• Substance use assessment, evaluation, and recommendations for treatment
• Depression and depressive episodes
• Suicidal ideation and self-injury
• Identity concerns, including gender identity concerns
• Adjusting to Caltech, your lab, your house, or the United States
• Crisis intervention services
• Post-hospitalization needs assessment and treatment planning

We also offer some specialty services on a limited basis, depending on therapist availability and clinical judgment:

• Therapy in Mandarin Chinese
• Couples counseling for relationship problems
• Exposure and Response Prevention (ERP) for Obsessive-Compulsive Disorder (OCD) and many phobias
• Mindfulness-Based Cognitive Therapy (MBCT), a group therapy focused on reducing the risk of relapse of depression or anxiety
• Cognitive-behavioral therapy for bipolar disorder
• Dialectical Behavior Therapy (DBT) skills groups for emotion regulation difficulties
• Transference-Focused Psychotherapy (TFP) for personality disorders (strictly limited to 1-2 students per academic year - this program is currently full.)

Services for neurodiverse students, or students on the autistic spectrum:

• Our neurodiverse students are a wonderfully diverse group with many different needs and goals for counseling. Talk with your clinician about your specific needs and how we can best work together to reach your goals.

Services we do not provide at Counseling Services include, but are not limited to:

• Treatment of eating disorders, which generally require specialized treatment over several academic terms, as well as regular coordination with medical services.
• Treatment of personality disorders, which are chronic concerns that usually require longer-term counseling than we can provide in our short-term model.
• Treatment for most types of psychosis (schizophrenia, delusions, hallucinations, etc.), which require longer-term supportive counseling and are best suited for work in the community.
• Assessments for attention difficulties (ADHD), learning disabilities, or for Emotional Support Animals (ESAs). However, we can provide referrals to local providers who offer these services.
• Requests for academic extensions; these requests should be directed to your professors or the Deans.
• Being seen regularly in counseling more than once a week. Though we can make exceptions for crisis situations, students who wish to meet more than once a week should obtain a referral to a community therapist who is able to honor this request.
• Rehabilitation or acute substance dependence problems, which generally require more intensive services than we are able to provide.
• Services to students who are located outside of California or the United States.
• Services via a text-only medium; however, we are happy to meet either in person, via our HIPAA-compliant Zoom service, or by telephone.

We also work with the entire campus to connect students with a broad range of supportive services. As part of the Caltech Student Affairs family, we are well-positioned to help students connect quickly with numerous services and supports beyond one-on-one counseling, such as:

• Health Services
• Occupational Therapy
• CASS (Caltech Accessibility Services for Students)
• The graduate and undergraduate Deans
• Academic advisors and tutors
• Equity and Title IX
• The Center for Inclusion and Diversity
• Peer support, such as Health Advocates and Peer Advocates

Eligibility

Eligibility refers to the ability to meet with our clinicians to determine an appropriate treatment plan; eligibility does not imply a right to ongoing services in-house beyond what the student and their clinician deem as an appropriate course of treatment within our model.

The following groups are eligible for our services:

• Currently enrolled graduate or undergraduate students, regardless of insurance coverage
• Most Summer students who pay a health fee, including SURF, WAVE, FSRI, VURP, and Amgen scholars.
• For couples therapy, at least one member of the couple must be a currently enrolled Caltech student.

The following groups are not eligible for our services:

• Students who are no longer enrolled at Caltech, whether due to graduation, separation, ineligibility, or medical leave. However, we can provide referral services to students in these situations for the purposes of connecting with providers. Students who separate from Caltech through graduation, ineligibility, or medical leave can, however, continue to use the TimelyCare service as long as they have an active access.caltech account. Go to timelycare.com/caltech to register an account.
• Students designated as special students through the Institute are visiting students enrolled in a graduate degree program at another school, and are not eligible for services.
• We cannot see students who live outside of California or the United States. Even though this is easy from a technological standpoint, California law nonetheless prohibits our clinicians from providing telehealth services to people in areas where we are not licensed.
• Caltech postdoctoral fellows, faculty, or staff are welcome to consult about students of concern, but are not eligible for direct therapeutic services. They are eligible, however, to use the Staff and Faculty Consultation Center.

Psychiatric services

• Meeting with our consulting psychiatrist through Student Wellness Services is possible for students who are also currently meeting with a counselor at Counseling Services. If a student stops working with their counselor here (for instance, because they are referred to a community therapist), then we will help student transfer their care to a psychiatrist in the community.
• This ensures that our office prioritizes our limited on-site psychiatric care for students who are currently also being seen by a Counseling Services clinician, and that the medical records are all in the same location for continuity of care.
• During the process of transferring care to a community psychiatrist, a small number of ‘bridge' visits is possible at the psychiatrist's discretion.

What about minors (students under 18 years of age)?

• In most cases, California law¹ allows minors 12 or older to consent to mental health treatment. There are 2 different statutes that cover this area, and clinicians may decide which one to apply. Please note that psychiatric services are not available to students under 18. In the first meeting with a minor student, clinicians will talk with them about the appropriateness of involving their parents or guardians in their treatment.

¹ Two statutes give minors the right to consent to mental health treatment. If a minor meets the criteria under either statute, the minor may consent to his or her own treatment. If the minor meets the criteria under both, the provider may decide which statute to apply. There are differences between them.

Family Code § 6924 "A minor who is 12 years of age or older may consent to mental health treatment or counseling on an outpatient basis or to residential shelter services, if both of the following requirements are satisfied:

(1) The minor, in the opinion of the attending professional person, is mature enough to participate intelligently in the outpatient services or residential shelter services. AND

(2) The minor (A) would present a danger of serious physical or mental harm to self or to others without the mental health treatment or counseling or residential shelter services, or (B) is the alleged victim of incest or child abuse."

Health & Safety Code § 124260 "[A] minor who is 12 years of age or older may consent to [outpatient] mental health treatment or counseling services if, in the opinion of the attending professional person, the minor is mature enough to participate intelligently in the mental health treatment or counseling services."