Counseling and Psychiatry Scope of Care
Counseling and Psychiatry (CAP) offers care that is provided by licensed mental health staff or direct supervisees, within an appropriate scope of practice, meaning delivering services consistent with level of training, experience, and competence. Services are provided to clients appropriate for outpatient mental health services while they are enrolled as students at UofSC Columbia. If it is determined that a client requires services outside of CAP’s scope of practice or care, staff will assist clients by providing an appropriate referral.
CAP will provide the following in-person and virtual services to UofSC Columbia students:
- Individual Counseling
- Group Counseling
- Couples Counseling
- Crisis Interventions
- Medication Management
- Educational Workshops
Exclusions to Care
CAP’s scope of care has certain exclusions. The list of exclusions below are guidelines only and decisions will be at the exclusive discretion of the Director of CAP and may include a clinical discussion with members of the CAP staff. Please note that not all clinical concerns are appropriate for Tele-Psychiatry/Tele-Counseling services.
Some examples of clinical issues that may need to be addressed through a community referral include but are not limited to:
- Individuals with chronic mental health conditions that require longer term, ongoing care, including some personality disorders
- The need to be seen more frequently than CAP can accommodate (beyond 1-2 times per month for individual counseling)
- Excessive utilization of urgent walk-in services indicating standard session frequency is inadequate. Excessive utilization of crisis services may be defined as walk-ins occurring weekly, in addition to weekly attendance of standard sessions.
- Chronic suicidality and/or recent history of multiple suicide attempts (inclusive of or greater than 2)
- Severe and chronic self-injury
- A history of multiple psychiatric hospitalizations (inclusive of or greater than 2)
- Multiple Relationships with a particular counselor/provider: A multiple relationship occurs when a CAP staff member is in a professional role with the client and at the same time is in another role with the client or may reasonably come into another role with the client. Consideration should also be made of developing relationships with others who might be in a close personal relationship with a client. CAP staff are to refrain from entering a multiple relationship if it could reasonably be expected to impair the staff member’s objectivity, competence, or effectiveness in performing their functions as a professional, or otherwise risks exploitation or harm to the client with whom the professional relationship exists.
Some Examples of issues that require more specialized care than can be provided at CAP include but are not limited to:
- Significant or chronic disordered eating symptoms
- Counseling and Psychiatry refers to the American Psychiatric Association’s guidelines regarding levels of care for the treatment of eating disorders. Pursuant to these guidelines, students who are significantly underweight, have severe co-occurring medical and mental health issues, are engaging in frequent bingeing and/or purging behaviors or severe restriction or excessive exercise, are in need of regular medical supervision, are unmotivated for treatment, or are unable to follow a treatment plan are considered outside of Counseling and Psychiatry’s scope of service. Students deemed beyond our scope of service may be referred for more intensive outpatient counseling or psychiatric treatment in the community, partial hospitalization or inpatient treatment, or may be advised to seek immediate medical treatment. These recommendations will be decided in consultation with the Eating Disorders Consultation Team.
- Significant or chronic substance use/abuse which compromises therapy or physical health and well-being
- Active symptoms of psychosis at risk for progressive deterioration
Other reasons why we may decline services and/or refer individuals to community resources include but are not limited to:
- Lack of motivation or engagement in treatment, as evidenced by:
- Unwillingness to provide information sufficient for clinical assessment
- Inability to identify treatment goal(s) appropriate for therapy
- Inconsistent attendance as evidenced by multiple cancellations or no shows, despite educational guidance offered by CAP (greater than 3 per semester)
- Attending sessions when intoxicated or under the influence of drugs
- Poor compliance with treatment recommendations
- Failure to follow through with recommended treatment in the context of multiple crisis intervention sessions
- Ongoing treatment relationship with another mental health provider to avoid duplication of service and/or mitigate conflicting recommendations
- Inappropriate, harassing, menacing, stalking, threatening, or violent behaviors toward other clients, staff, or contract employees
- When any clinical staff member determines that treatment would be detrimental to the client or to the proper functioning of CAP
- Other situations that are determined to be outside the scope of services as defined by the Director of CAP
Mandated or required treatment is not offered by CAP, including but not limited to:
- Counseling ordered through legal proceedings, such as substance abuse treatment, alcohol education, anger management, parenting education, or domestic violence treatment
- Counseling required by employers, government agencies, academic faculty or departments, or classes
- Court mandated treatment. If the student is already in treatment with CAP when the mandate is given, the only documentation we can provide is a verification of visit.
- Comprehensive psychological evaluation of any type, including but not limited to:
- Neuropsychological evaluations
- Forensic assessments, including but not limited to custody disputes, fitness to stand trial, or not guilty by reason of insanity arguments.
- Custody evaluations
- State/Federal benefit programs, including vocational rehabilitation and Social Security/ disability
- Fitness-for-duty evaluations
- Presurgical mental health evaluations
CAP medication management providers will not regularly prescribe benzodiazepines or z-drug sleep medications (Ambien, Lunesta, Sonata, etc.) to students. Students seeking these classes of medications will be referred off-campus. The prescribing of any medication is at the discretion of the psychiatric provider. There are some clinical issues that may not be appropriate for Tele-Psychiatry (see Exclusions to Care above). One’s clinician, in consultation with the Director of Counseling and Psychiatry and the Chief of Psychiatry, will determine if the student is a good fit for Tele-Psychiatry. If indicated, the student will be assisted with finding off-campus referrals.
Students requesting medication services for Attention-Deficit Hyperactivity Disorder (ADHD/ADD) must first receive formal psychological testing to confirm the diagnosis. Having previously been prescribed medication by a physician does not replace the need for psychological testing. Students who have not been tested may contact Counseling and Psychiatry to assist them with making the arrangements to get testing completed, because Counseling and Psychiatry itself does not offer ADHD testing services. The cost of this testing is NOT covered by the Student Health Fee. Test results will be accepted from off-campus or out-of-state psychologists if they comply with CAP guidelines. Once students’ test results are received, reviewed, and approved, students will be contacted for an appointment with a psychiatric provider. The prescribing of any medication is at the discretion of the psychiatric provider.
CAP will provide excuses for absences at the discretion of each provider/counselor according to the University of South Carolina attendance policy for established clients of CAP who have an ongoing relationship with a provider in this clinic.
CAP will not provide documentation for UofSC Housing Accommodation Requests.
CAP clinicians will complete a letter of support for students that are actively engaged in CAP services, and for whom they have met frequently enough to determine clinical impact upon academics. The student may be referred for testing to assist with this determination. The letter will be transmitted to the Student Disability Resource Center (SDRC) on behalf of the student when a Release of Information is signed allowing us to share clinical information with them. The SDRC will then determine appropriate accommodations if clinically indicated. Please note that accommodations are not retroactive and only begin once the student is formally registered with the SDRC.
CAP will not write letters for Emotional Support Animals (ESA) in accordance with American Counseling Association’s 2019 recommendations. A clinician cannot predict an animal’s behavior, and an emotional support animal is quite different from a service animal. In addition, an ESA is a recommendation of the provider rather than procured at the request of someone seeking an ESA.