How UPenn Cut Counseling Wait Times in Half Without Hiring More Counselors

Classes at the University of Pennsylvania begin in late August, but September is when students’ counseling needs see a spike. The influx of patients inundates counselors’ caseloads, filling up their schedules weeks or months ahead of time. And for years, the university’s counseling center was perceived as slow-moving and bureaucratic.

Student concerns were chronicled year after year in the college newspaper, The Daily Pennsylvanian, and their sentiments largely echo what students have been saying across the country at different campuses: It’s tough to get access to campus mental-health care.

So in April 2018, when Meeta Kumar assumed her role as deputy executive director of the Counseling and Psychological Services center — often referred to as CAPS — she was determined to change that perception.

The center’s leadership team spent a little over three months last summer overhauling the framework for scheduling appointments. A pilot program, begun in the fall of 2018, aimed to more efficiently connect students to mental-health services. The result was a significant reduction in average wait time to see a counselor — half of the time reported in the fall of 2017 — from 12 waiting days to six, according to Kumar. Despite a 23-percent increase in the number of appointments made from 2017 to 2018, the center carried its weight.

How did the center do it? Administrators studied data and student complaints. The goal was simple. They wanted to, among other things, alleviate the long wait times, reduce students’ barriers to care, and help them get access to mental-health professionals quicker. These are issues ailing many campus mental-health centers — more students are seeking counseling, but universities have limited resources to tackle the increase. So, administrators did the obvious: They cut red tape.

There were minimal additions to the center’s clinical staff, although some operational roles were added, Kumar said. “We wanted to provide an immediate response to students engaging with us,” she said. The effort to expand access to mental-health care and reduce wait times was also spurred on by campus leaders, she noted.

Building Capacity

The old system felt “cumbersome” to students, Kumar said. Ultimately, it affected students’ perception of the clinic and whether they wanted to seek help there.

The leadership team, which consisted of Kumar and four additional directors, evaluated data on how students used CAPS. They identified weeks and months when the center saw an increase in patients, said Cynthia Boyd, director of training.

“What happens is that staff had to quickly fill their caseload during busy months, which makes it hard for them to pick up clients later,” she said. To reduce wait times, the center maximized the slots available for initial assessments, so students could touch base with a counselor.

The team had numerous conversations with social workers and counselors to identify what could be improved, such as balancing the staff’s patient case load. They also examined different university models, such as the 24-hour phone counseling at Swarthmore College and the University of Texas at Austin, but ultimately established their own approach.

After their evaluations, administrators reworked staff duties and created a master appointment schedule to “build up clinical capacity,” Kumar said.

The staff members want students to receive an immediate intervention, instead of feeling like they are on hold. “They can walk away feeling like they’ve addressed a problem,” said Miki Saraf, the deputy clinical director of the center. “It’s a feeling of satisfaction.”

Jane Kotler, the assistant director of clinical administration and a member of the leadership team, was charged with supervising a new workflow for clinical staff. Front-desk staffers now have access to the center’s master schedule to schedule appointments for students, which Kumar said was one of the most significant changes.

Previously, front-desk staffers were not as involved in the scheduling process, which was a hurdle for students seeking care. That responsibility was reserved for clinicians, whom students had to schedule with after their initial screening. It was a tiered process that prioritized urgent cases over milder ones, and relied on counselors to follow up.

“They really had to change their job functions,” Kotler said. “The staffers are not there to make clinical decisions, but they have the tools to ask the right questions to help students.”

A Streamlined Model

The center used to conduct brief triage screenings, either on the phone or in person, before students could make a counseling appointment. The first appointment was an “initial assessment,” which identified whether the student would segue into longer-term care, Saraf said.

The new model skips the triage stage. Students can schedule an assessment ahead of time, or drop by the center during working hours if they have an immediate need. There is also a 24-hour phone line students can call to reach a clinician, an expansion of CAPS’s after-hours care that differs from the university’s public safety call line.

The changes respond to students’ varying needs: Some might want a few counseling appointments, while others need longer-term care. A small percentage of students look for an outside practitioner or need to see a member of the psychiatry team for medication, Saraf said.

And the streamlined model allows these students to bypass the initial evaluation phase, meeting directly with professionals — whether it is someone who can prescribe them medication or coordinate a referral with an outside therapist.

Removing the first screening helped counselors devote more attention to the students coming in, said Valeriya Spektor, a staff psychologist on the drop-in counseling team. Spektor and other clinicians on the drop-in staff primarily see students who come by the clinic with an immediate need.

In addition to seeing patients, in her former role, she dedicated time to call students back for assessments or scheduling. That meant lots of back-and-forth phone calls, and not enough clinical contact, she said.

“More students are benefiting from having a consultation with a clinician in person,” Spektor said. “Even if they don’t know if long-term therapy would be helpful.”

Follow Terry Nguyen on Twitter at @terrygtnguyen, or email her at terry.nguyen@chronicle.com.