Risk Management Series 2- Treating the College Student: Risk Considerations for Behavioral Health Professionals

Tip #1: Treating the College Student


As a behavioral health provider, you may have patients who go off to college - either in or out of state. This can be a difficult transition for the patient, as well as you, as the provider. There may be some challenging issues and decisions about treatment. A few questions come to mind:

  • Where will the patient be attending school - in or out of state - and is it likely that he/she will return to resume treatment with you again?
  • Do you continue treating the patient or refer the patient to a local provider - either at school or close by?
  • What if the patient decompensates, and he/she is not in close proximity to your office?
  • What about using telebehavioral health for treatment?
  • What happens when he/she is on break and returns home? Do you continue treating the patient?
  • What if you only treat minors, and the patient is now an adult?
  • What if the patient revokes consent for you to talk with his/her parents?

These are all difficult questions, and there may not be a clear answer. Each case is different. There are some risk management considerations to keep in mind, however, that could be useful when treating a patient who heads off to college.

  • It is important to prepare ahead of time. You may maintain some contact, or none at all, and treatment may stop altogether. Discuss and prepare with the patient and his/her family (provided you have appropriate consent).
  • It is important to transition. Set appointments with the patient to transition, either on the phone or in person. This may be a difficult time for him/her. If the patient is located out of state, you may not have proper licensure to provide a transition via phone. Check state regulations prior to doing so.
  • Link the patient with local professional supports. As your patient transitions into college life, it will be important that he/she has professional support available to assist with ongoing issues as well as new issues that arise. Many colleges offer health/mental health services. It may be important to link your patient with a provider located near or at the college to provide ongoing support. This may be extremely difficult as you may have a long-term or close relationship with the patient and his/her family. Nevertheless, ensure that the patient has local support, particularly if there is potential for decompensation or increased challenges. Depending upon the location, you may have professional contacts in the area or, if not, consider contacting the college health services to obtain resources for the patient. It is also important to have proper consent to communicate with other providers.
  • Location is important. Whether the patient is in or out of state, it may be extremely difficult for the patient to maintain regular appointments, if at all, given his/her schedule and ongoing life as a college student. Keep in mind differing issues with the patient who attends school in state as opposed to the patient who attends school out of state. If the patient is attending school out of state, there are additional considerations such as licensure requirements. Consider contacting your state board of licensure and also the board located in the state where the patient will be attending school. It is important to be aware of any disciplinary action you could suffer when not adhering to relevant rules and regulations.
  • If services are billed through insurance, determine if the patient’s insurance will continue to reimburse for services while the patient is at school. If the patient is out of state, his/her insurer may not provide coverage for you to continue services. It is important to know this ahead of time.
  • Ensure the patient is aware of how to access emergency services should he/she need it. Discuss when to seek emergency care and how to do so. Providing information on available emergency services in the patient’s area is advised.
  • Determine if you are able to have “check in” sessions with the patient. When you do this, keep in mind that you likely maintain a provider/patient relationship. If you have already terminated with your patient, the clock starts running again with subsequent patient encounters. For example, a state may have a 30-day requirement for termination. If within that 30 days, you have a brief session on the phone, the time frame for termination may begin again from that date. Check with your licensing board to ensure you are complying with relevant regulations. Certainly, there may be times when a patient needs to contact you when he/she is having difficulty. If you are faced with this and, it is possible, seek advice or consultation on next steps.
  • Examine whether you can resume treatment when the patient is on break. Keep in mind that when you do this, as indicated above, the time frame for termination may start again even if you previously terminated with the patient. You will be bound to termination rules in your state. However, college students may return home for the summer or extended times during break. If the patient is engaged in treatment with a provider near his/her college, when able, and with proper patient consent, communicate with the provider to ensure continuity of care. Each case is different, and it may be reasonable to resume treatment again.
  • The patient may not return home. This is particularly important as the patient may not return to a location where he/she can continue treatment with you. When it becomes apparent that the patient is not returning home and continuing treatment with you is no longer in the patient’s best interest or is practical, it is recommended to transition and terminate care.
  • The patient’s parent contacts you to advise of difficulties. Difficulties may arise during periods of transition. You may receive a call months later indicating the patient is not doing well or struggling. If the patient has an ongoing treatment provider near college, encourage the parent to contact the local provider. It is important to determine the next course of action depending upon the situation as well as your relationship with the patient and his/her parents. Seek advice if you should have questions on the best course of action.
  • Your patient revokes consent to talk to his/her parent. Consider this scenario - the patient, who may have been a minor during your treatment, is now an adult and revokes consent to talk to his/her parent. There may be times where concern is elevated, particularly if there are safety issues. Know what the rules are for duty to warn/protect and when it may be warranted to talk to the authorities or parents, depending on the situation and your state laws since there may be times when notification is necessary even in the absence of patient consent. Put safety first.
  • You started treating the patient as a minor and he/she is now an adult; you do not treat adults. Depending on your practice, you may continue seeing the patient for a period of time as he/she transitions. However, your group/facility may prohibit you from doing this. Always be mindful of your background and training and whether you have the requisite skills to see a patient, or if it is outside your scope.
  • When in doubt, seek advice. As mentioned previously, each case is different. Seek advice from an attorney should you have questions.
 

Kristen Lambert, JD, MSW, LICSW, CPHRM, FASHRM
Healthcare Practice and Risk Management Innovation Officer
Trust Risk Management Services, Inc.
email: contact@trustrms.com

 

NOTE: This information is provided as a risk management resource and is not legal advice or an individualized personal consultation.  At the time this resource was prepared, all information was as current and accurate as possible; however, regulations, laws, or prevailing professional practice standards may have changed since the posting or recording of this resource. Accordingly, it is your responsibility to confirm whether regulatory or legal issues that are relevant to you have since been updated and/or to consult with your professional advisors or legal counsel for timely guidance specific to your situation. As with all professional use of material, please explicitly cite The Trust as the source if you reproduce or distribute any portion of these resources.  Reproduction or distribution of this resource without the express written permission of The Trust Companies is strictly prohibited.

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NOTE: This information is provided as a risk management resource and is not legal advice or an individualized personal consultation. At the time this resource was prepared, all information was as current and accurate as possible; however, regulations, laws, or prevailing professional practice standards may have changed since the posting or recording of this resource. Accordingly, it is your responsibility to confirm whether regulatory or legal issues that are relevant to you have since been updated and/or to consult with your professional advisors or legal counsel for timely guidance specific to your situation. As with all professional use of material, please explicitly cite The Trust Companies as the source if you reproduce or distribute any portion of these resources. Reproduction or distribution of this resource without the express written permission of The Trust Companies is strictly prohibited.