Curry Health Center (CHC)
2011-2012 Assessment: CAPS Triage-Screening Appointment Study
Submitted by David Brown, CAPS Psychologist
ABSTRACT
In recent semesters, students seeking individual psychological counseling at Counseling and
Psychological Services (CAPS) have had to wait for as long as three weeks for an initial face-toface appointment with a counselor during the busiest weeks of the semester. In the effort to
reduce wait times, to more quickly determine urgency of need for counseling, and to more
efficiently manage appointment flow, CAPS implemented a triage/screening system at the
beginning of the Spring 2011 semester. A portion of clinical time usually devoted to hour-long
counseling appointments was devoted to half-hour triage/screening appointments to determine
the nature and urgency of a student’s counseling needs. Following this change, wait-times both
prior to and following the change to a triage system were studied to ensure that wait times for an
initial face-to-face meeting (a 30-minute screening appointment) had notably improved. Results
indicate that the triage system consistently reduced the wait for an initial face-to-face meeting for
the Spring 2011 semester and did not significantly increase wait time for a first hour-long
appointment, when compared with Spring 2010. In the Fall 2011 semester, however, the triage
system was not as effective at reducing wait times and changes have been recommended to
address this problem.
BACKGROUND
A factor in delivering effective counseling services is providing such services in a timely
manner. When University of Montana students seek counseling services they may be in need of
immediate help, such as when a student is feeling compelled toward suicide, or they may be able
to wait for a reasonable number of days such as when seeking help with improving social skills
or addressing long-standing relationship problems. In recent years, the University of Montana
has experienced rising enrollment and, typical of almost all university/college counseling
centers, an increase in the percentage of students seeking individual counseling. At the same
time, hiring constraints have meant that additions to CAPS’ professional counseling staff have
not kept pace with demand. These circumstances have resulted in steadily increasing wait times
to begin counseling, following an initial request for an appointment.
For a variety of reasons, long wait times, apart from inadequately serving individual students,
also result in more missed and cancelled appointments once the time has arrived. Such no-shows
and cancellations waste clinical hours at a time when such hours are under especially high
demand and in short supply. By far, the most worrisome concern is that some students with
urgent mental health needs may be waiting too long for an appointment. Although CAPS offers
same-day crisis services, usually meeting the student within the hour, students are asked to selfselect with regard to the urgency of their need. Because their first point of contact is with busy
reception staff who do not have formal clinical training, students may not always be adequately
assessed for more subtle signs of urgency of mental health needs. During busy times, such staff
are in the awkward, stressful position of trying to determine whether a student can wait for an
appointment or should be encouraged to come in for a same-day appointment. Reception staff
are trained to err on the side of caution and offer immediate service if a student seems to indicate
that their needs are urgent. However, some students whose needs may be quite urgent may not
identify themselves as such due to ambivalence about seeking help or not wanting to be viewed
as particularly in need or otherwise vulnerable. As numbers of students with suicidal thoughts
and impulsivity toward acting on suicidal thoughts have increased nationwide, CAPS
professional staff have become increasingly worried about excessive wait times without any
formal process in place to assess the urgency of a student’s need.
During the Fall 2010 semester it was decided that CAPS would implement a triage system, in
Spring 2011, using professional staff to meet with students for a half-hour appointment to
determine the nature and urgency of their counseling needs. The initial goal was to “triage” all
students calling for a first-time appointment within two to three days of their initial request.
Students continued to have the option of coming to counseling immediately if the student or
receptionist believed their need was urgent. It was understood that the new system might
increase wait times for a full hour-long counseling appointment, but it offered the advantage of
better determining which students might be at greater risk of deterioration of their mental health
or other life circumstances if not seen quickly.
The purpose of this process was threefold: 1) to determine the average length of wait for a faceto-face appointment with a professional counselor at times of modest demand and heavy demand
during the Spring 2010 semester (i.e., before a triage system was implemented), 2) to implement
a triage system, using briefer initial appointments, with the aim of seeing all students requesting
an appointment within 2-3 days of their appointment request, and 3) to verify that these changes
improved wait times for a first contact with a clinician during the Spring 2011 semester.
Studying wait-times during the same two-week span in consecutive Spring semesters was
intended to ensure that wait-time samples were taken during periods of similar appointment
demands.
PROCEDURE
During three separate two-week periods coinciding with predictable periods of higher demand
during the Spring 2010 and Spring 2011 semesters, time spans were measured starting with the
date of a student’s request for an appointment and ending at the date of the first face-to-face
interview by a clinician.
Data was collected from CAPS Medicat EMR (electronic medical records) scheduling and
service records. Unfortunately, report data generated by Medicat’s integral data reporting
program was frequently unreliable and, to ensure accuracy, all of the data reported below was
generated by examining individual client records within Medicat. The data was collected and
analyzed by a CAPS clinical psychologist with extensive experience in research design and
statistical analysis.
A total of 50 client records were reviewed for each time span to sample different date ranges
within each semester. Time spans were measured from the date the appointment was requested
to the first face-to-face meeting between the student and a professional counselor. Records were
not used for those students who called to change their appointment dates to a later date.
FINDINGS
In the Spring 2010 semester the wait times for a face-to-face appointment with a CAPS therapist
were as follows:
Spring Semester 2010
Weeks 2-3
Weeks 7-8
Weeks 12-13
Weeks 1-16
Avg. Wait from
Appointment Request to
Intake (Days)
5.1
9.2
17.5
9.9
In the early weeks of the semester, wait times were not excessive, but by weeks 12-13 students
were waiting an average of 17.5 days for an appointment. During this span, CAPS did not
generally have any information about the nature or urgency of a student’s need.
Given a proposed goal of meeting face-to-face with any student requesting an appointment
within 2-3 days of that request, the data suggest that CAPS fell far short of that ideal goal in
Spring 2010.
Following the implementation of the triage system, data was collected from the Spring 2011
semester using the same sampling procedure for the previous Spring semester.
Spring Semester 2011
Weeks 2-3
Weeks 7-8
Weeks 12-13
Weeks 1-16
Wait for Triage
Meeting (Days)
2.00
3.25
4.07
2.72
In its first full semester, the new triage system came quite close to meeting the performance goal
of having a face-to-face meeting within 2-3 days of any student’s request for service. The
average wait for the entire semester did fall within this range, but several individuals had to wait
for up to 5 days for a triage appointment late in the semester.
Although not originally planned as a part of this assessment, wait-times were examined for the
Fall 2011 semester to ensure that there were not notable differences between Spring and Fall
semesters.
Fall Semester 2011
Weeks 2-3
Weeks 7-8
Wait for Triage
Meeting (Days)
4.28
7.54
Weeks 12-13
Weeks 1-16
5.14
6.26
The data indicates that the triage system faltered during the Fall 2011 semester and wait times for
triage more than doubled when compared with Spring 2011. Average wait times for a triage
appointment during the entire semester grew from 2.52 in Spring 2011 to 6.2 days in Fall 2011.
However, this continued to be considerably less time than the wait prior to the implementation of
the triage system.
RECOMMENDATIONS
It is clear that the newly implemented triage system has substantially improved the problem of
long wait times for a first assessment of a student’s mental health status and needs. However, it
is equally clear that the system needs further study and adjustment. A CAPS committee was
formed in Spring 2012 to address the problem of increased wait times in the Fall 2011 semester
and to make general recommendations for more efficient and prudent scheduling. Although
overall demand is not usually higher over the course of the semesters, requests for appointments
are considerably higher earlier in the fall semesters than in spring semesters. When demand for
appointments is high but there are also many open full-hour appointment slots early in the
semester, using times for triage appointments rather than just starting the student’s counseling in
a full hour-long slot is not efficient. An extra half-hour of clinical time is thus being used
unnecessarily. The recommendation of the committee formed to address problems in the triage
system is to hold off on implementing the system each semester until the wait for a regular
appointment has begun consistently to exceed the usual wait for a triage appointment.
Additionally, the committee recommended ongoing formal tracking of wait-times to better
predict fluctuation in demand during Fall versus Spring semesters. Finally, because there were
several complaints voiced by students about the inconvenience of coming for a screening
appointment but not truly beginning formal counseling at that time, a recommendation was made
to conduct a satisfaction survey of students who’ve been through a triage/screening appointment
at CAPS. A satisfaction survey is being developed and will be directed at students using services
in Fall 2012.