Teams of six to eight CAPS staff discuss each student's treatment — often without their knowledge

Counseling and Psychological Services at Penn is composed of approximately 35 staff members  — psychologists, social workers, postdoctoral students, interns, and prescribers — who are organized into five treatment teams of six to eight members. These groups meet weekly to discuss any problems that may surface on any team member's student cases.

While other universities often employ similar staff structures, students are not always told that these treatment teams exist. Consequently, they are not aware that the personal information they share with their therapists often extends past their private sessions and into the teams' weekly meetings. 

Although every senior staff member of CAPS staff is licensed to practice in the state of Pennsylvania, the team system allows postdoctoral students and interns at CAPS who do not have that license to sit in on and contribute to conversations relating to students' treatment.

In addition, these treatment teams are reshuffled every three years, sometimes forcing students to switch psychiatrists.

Some students say that information surrounding this team system needs to be made more accessible, particularly because it has direct implications on the way they understand their own treatment. This is also not the first time that students have called for CAPS to improve its communication to the student body. 

CAPS provides referral services to students over the summer, though many have indicated that they are not aware of this. Similarly, CAPS representatives have said that students have the ability to extend their treatment if they want to, though many have said that they were referred out of CAPS against their will and did not know that they could choose otherwise. 

Why these treatment teams exist 

"The teams at CAPS are structured so that each member brings a different area of expertise to the conversation," CAPS Director Bill Alexander said. "There is typically one person on team who can prescribe medicine, one psychiatrist, and one clinician. This was designed to improve the care that the student receives," Alexander said. 

“It’s very important in medicine that the prescriber and therapist are in close collaboration and consultation about the student,” he said. “That can happen most easily if the prescriber has to collaborate with a fewer number of therapists.”

The weekly team meetings are also a chance for staff to brainstorm treatment options and have others weigh in on clinical decisions.

"It's a chance for the team to sit down together and say here are the issues we’re dealing with with the clients on our team," Alexander said of the weekly meetings. “It's like a mini cross-section of CAPS."

Engineering sophomore Katie Waltman, who received treatment from CAPS last year, said she has still never heard of the treatment team structure before. She expressed concern that her privacy might not have been preserved if a team of CAPS staff were discussing her treatment. 

"People think that they’re having a very private conversation when they see someone like a therapist or psychologist," Waltman said. "But looking [at the] bigger picture, I guess they’re looking out for you and they’re trying to discuss the best possible options for you.”

Waltman, who is a Daily Pennsylvanian staff member, added that she wished there was more transparency in how CAPS is organized.

"I think it would be nice if they were more upfront about their whole team system," Waltman said.  "It's a little odd." 

Alexander said that the team structure is typical for counseling centers at other universities, though representatives at Counseling and Psychological Services at Cornell University have said their services are not organized in this way. In terms of resources and services, Cornell's CAPS closely resembles the center at Penn. 

It has five prescribers and 35 to 40 therapists, comparable to Penn, and serves approximately 20 percent of the student body — also similar to Penn, which serves 20 percent of undergraduate students and 16 percent of graduate students. 

Cornell CAPS Clinical Administrative Assistant Susan Stifel said she was not aware of a team structure at the department. Cornell CAPS Director Gregory Eells noted, however, that the team system is a "common model," and that the culture of an institution is a contributing factor to how a school chooses to structure its counseling center. 

Cornell’s CAPS pursues an informal collaborative care model, which could include staff working together at lunch as well as clinical meetings between therapist and psychiatrists every week.

When students' treatment plans get disrupted 

Another implication of Penn’s model of treatment teams is that the teams are restructured every three years, which might cause disruptions in students' treatment. The last restructuring happened over the summer. 

After the restructure, therapists and providers who previously worked together on a team were assigned to different teams. For students who receive treatment for longer than a semester and who came back after the summer to continue that treatment at CAPS, Alexander said the system would automatically link them with their therapist in the shift. For some, this means starting over with a new psychiatrist.  

He added that if a student's therapist and psychologist end up on separate teams, CAPS would not force the student to switch prescribers. 

This was not the case for College junior Ariel Epstein, who until this semester worked primarily with her CAPS psychiatrist and not her therapist. At the end of this past summer, Epstein sent a routine email to her CAPS psychiatrist to set up a meeting to continue her treatment and renew the medication he had been prescribing for her since January, but she was surprised to learn that her treatment team had changed. 

Her therapist had been placed on a new team, which meant she would have to switch psychiatrists. Epstein then met with her therapist to inquire how to get her prescription refilled, and was told she had been referred out of CAPS completely.  

Alexander said that if a student requests to stay with their psychiatrist rather than therapist, CAPS would accommodate the student. But Epstein said she didn’t even realize that asking to stay with her psychiatrist was an option.

“The problem is there’s no cohesive policy or communication of that policy among the different higher-ups in CAPS,” Epstein said. “Definitely a structural reorganization of CAPS needs to be made.”