Recommendation Report to Improve

Counseling and Psychological Services

(CAPS) Screening Process at Indiana
University, Bloomington

Submitted to: Nancy Stockton, Director of CAPS

Created by: Mallory Baldini, Cameron Ivory, William Nommay, Monica

Strauss, and Jacob Wainwright,
Indiana University Students

December 12th, 2016

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Table of Contents
Executive Summary ................................................................................................................................iii
Introduction ................................................................................................................................................ 1
Problem in Detail ...................................................................................................................................... 1
Methodology and Scope ......................................................................................................................... 3
Table 1 .................................................................................................................................................... 3
Figure 1 .................................................................................................................................................. 4
Visual 1................................................................................................................................................... 4
Solutions ...................................................................................................................................................... 5
Visual 2................................................................................................................................................... 6
Conclusion .................................................................................................................................................. 7
Recommendations .................................................................................................................................... 7
Appendix A ................................................................................................................................................ 9
Appendix B.............................................................................................................................................. 11
Appendix C.............................................................................................................................................. 12
References ................................................................................................................................................ 13

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Executive Summary
Our group has observed that many Indi ana Uni versi ty students struggle wi th
accessi ng the resources that the Counseli ng and Psychologi cal Servi ces, or CAPS,
offers i n a ti mely fashi on. After observi ng thi s, we compi led a recommendati on
report that analyzes the extent and repercussi ons of thi s problem on campus.

From conducting our preliminary research, we concluded that there are three major areas
that deserve focus, including: inadequate website content, a lengthy and time consuming
screening process, and a lack of available medical personnel.

In order to go about solving this problem, we began with reviewing the CAPS website.
Then, we interviewed the director of CAPS to get some insight as to how the screening
process works. Next, a group member interviewed a student who has first-hand
experience with going through the screening process. Additionally, we conducted a
survey and distributed it to several undergraduate students from diverse demographics.
Lastly, we conducted a brief literature review that focuses on the mental well-being of
college students around the country.

Our group believes that the following set of recommendations will have a positive effect
on Indiana University students who are having trouble accessing the resources that CAPS
offers in a timely fashion.

Recommendation 1: Revamp the CAPS website and the application process to make
them more transparent for students.

Recommendation 2: Hire more psychologists and psychiatrists.

Recommendation 3: Host an enrollment fair on campus to expand awareness of CAPS

existence and services.

We conclude the report by discussing a combination of recommendations that we believe

will best solve the current issue that CAPS and its users are experiencing. We propose a
combination of solutions 1 and 2. We recommend revamping the CAPS website and the
application process in order to make them more transparent for students. Additionally, we
recommend hiring more psychologists and psychiatrists.

We are confident that these recommendations will ultimately benefit the CAPS faculty by
expanding the amount of help they receive on a daily basis. Additionally, the overall
screening process will be greatly improved, and CAPS will accomplish everything it sets
out to do. These recommendations strive to help students across campus that may be
suffering from mental illness and stress.

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Introduction
College students all over the country suffer from stress and anxiety due to the high
pressures and competitiveness of college. Indiana University has established the
Counseling and Psychological Services (CAPS), which helps students who may be
suffering from stress and anxiety. CAPS is the only service on campus of its kind for a
student population of roughly 48,000.

As students of Indiana University, we recognize the importance of helping students deal

with the stressors of school and life. We appreciate everything that CAPS does, but in a
world where competition and excellence are stressed more than ever, CAPS must update
its screening process. On September 22 of this year, we submitted a proposal for
permission to research the current screening process that CAPS employs.

Since the approval of our proposal, our group has conducted extensive research to
analyze how students view the effectiveness, or lack thereof, regarding the CAPS
application process. In order to solve this problem, we began with reviewing the CAPS
website. Next, a student who is familiar with how the screening process works was
interviewed. Additionally, a survey was distributed to undergraduate students to get a
sense of their general states of well-being and their opinions towards CAPS. Lastly, a
brief literature review was conducted that gives us some insight to mental health on
different college campuses around the country. After all of our research was conducted,
we came up with several recommendations that could be made to improve the way the
website looks and how the screening process works. This report analyzes the
recommendations by considering and weighing criteria such as cost, effectiveness, and
faculty and student feedback.

Problem in Detail
Mental health is a dimension of general well-being that is often stigmatized and can have
adverse effects on an individuals personal, social, and academic livelihood. College aged
individuals are at a heightened risk for developing mental health issues due to many
mental health disorders manifesting around the age of 18-24, including anxiety disorders,
mood disorders and substance disorders. Another factor to the elevated incidence of
mental health issues in college students, and therefore an elevated need in mental health
services, is the stressors associated with classes, social changes, monetary stressors, and
in many cases a first introduction to true independence.

Studies have shown that 95% percent of college counseling center directors said that the
number of students with a significant psychological problem is a growing concern on
their campus, and there is a desperate need to address this issue. Adequate services that
have enough staff and a streamlined process to get students the help they need in a
reasonable amount of time is essential to meet the growing frequency of mental health
issues on college campuses. A survey conducted by the National Alliance on Mental

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Health titled College Students Speak interviewed 765 individuals who had mental
health issues diagnosed during their college years. The report sheds light on the growing
problem of mental health on college campuses and the inadequacy of the resources
offered to these populations. 73% percent of the respondents experienced a mental health
crisis while in college and of this 73%, 35% said that their college counseling service did
not know about this crisis. Another important indicator of the effectiveness of the
counseling services offered by a college is the wait time. 39% percent of survey
respondents said that their wait time was more than five days. The percentage of survey
respondents that were no longer attending their college because of a mental health related
reason was 64% (Gruttadaro, D. & Crudo, D., 2012).

Indiana University is not immune to this problem. With a student enrollment of over
48,000, the need for a counseling and psychological service that is adequately staffed, has
information for the student body, and has an intake process that is capable of handling the
enormous student body is essential. After interviewing an individual who had direct
experience with Indiana Universitys Counseling and Psychological Services, it seems
that the needs of many students are not being met. The individual described a process that
began with an initial 30-minute meeting with a member of the intake staff, followed by a
scheduled meeting with a therapist who will assess your mental status and determine if
you need to see a psychiatrist. The individual had this to say about the second meeting:
This hour long appointment requires you to basically re-explain all that you
explained previously to the intake member, which is rather inefficient and
requires the psychological issues that one is experiencing be the same a week
after intake that they were on the day of the first appointment: for obvious reasons
this is quite often not the case.

To see a psychiatrist and receive medication, the patient must be recommended by the
therapist seen at the second meeting. This entire process from the first intake to seeing a
therapist can take up to two weeks and being able to see a psychiatrist takes much longer.
When asked about this individual students outcome after going through the process, they
had this to say:
Moreover, although there have been a number of times that CAPS have assisted
me in my academic endeavors, the entire process and the length of time required
did play a role in my ultimate medical withdrawal from IU, because I genuinely
believed the process of going through everything I had to in order to be helped
would take so long that I had much better chances seeking help elsewhere.

The current resources and process this student encountered resulted in a withdrawal from
the university, which is much too common. By providing CAPS to students, Indiana
University is making an effort to address the mental health needs of all of its students.
However, as the student population continues to grow, these services must adapt to
support the needs of all students.

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Methodology and Scope

Research methods used can be found in Table 1.
Task Timespan

Interviews of student and faculty member One week

Survey of students Two weeks

Review and analyze interviews and survey One-two weeks

Review CAPS website One week

Plan ways to improve CAPS Two-three weeks

Table 1: Methods and time devoted to gather recommendation information.

Interviews of Student and Faculty Member

In order to gather adequate data, we began our research by interviewing an Indiana
University student and a CAPS faculty member. We questioned a student who had first-
handedly experienced the process of waiting to see a psychiatrist. An interview with
Nancy Stockton, the Director of CAPS, gave us insight into the CAPS staff and how they
view the process of student appointments. Nancy Stockton was able to give us valuable
input regarding how their team is understaffed. From our interview with Nancy Stockton,
we learned that the ratio of staff members to students is about 1 to 2,200.

The scheduled interviews with an Indiana University student and the Director of CAPS
were free of charge. The interviews took approximately 20 minutes of their time, and
resulted in our gain of useful report data. Copies of the two interview transcripts can be
found in Appendices B and C.

Survey of Students
A survey was created and distributed to members of the Indiana University student body.
We sent the survey out on November 15th, and it stayed open for two weeks. The survey
consisted of eight questions, inquiring about the students knowledge of CAPS,
experiences with CAPS, and their own mental health.

The cost of initiating this plan was non-existent. Our survey was created and distributed
electronically through a free online survey and questionnaire tool called SurveyMonkey.
A copy of the survey questions can be found in Appendix A.

Reviewing and Analyzing Interviews and Survey

Results of the survey offered substantial information regarding how Indiana University
students view mental health. The feedback we received showed us that students are
concerned with their own mental health, as well as the mental health of others. However,

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most students are unaware of how to seek assistance through CAPS. This is valuable
information that allows us to defend the need for an overall improvement of the CAPS
screening process.

Figure 1: Survey Results

Reviewing CAPS website

Upon reviewing the CAPS website, we found extensive information including signs that
a student may need mental help, groups you can join for specific mental issues, and how
to help others. However, the only resource given in order to make an appointment to see a
psychologist was a phone number. There was no additional information given about the
process for students who need immediate help.

Visual 1

Scope
Our research focused on the current details of CAPS, faculty and student opinions of their
services, and the mental health of students. The single goal of this report is to benefit the
mental health and stability of students on Indiana Universitys campus.

All aspects of our research were closely examined and considered while we were
devising our final recommendation and list of steps to take action.

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Solutions
Our group spent sufficient time brainstorming several solutions that could solve the
problem that CAPS and the students on Indiana Universitys campus are currently facing.
We came up with several criteria including effectiveness, cost of implementation, and
faculty and student feedback.

Solution 1: Revamp the CAPS website and the application process to make them
more transparent for students

Our survey concluded that many students who have tried using CAPS have ultimately
been unsuccessful because the website is uninformative and the application process is not
as efficient as it could be. Consequently, many students who are in need of psychological
attention are unable to navigate the application and are left without necessary care. Our
group proposes that the CAPS website be revamped to include more information and that
the application process be made more transparent for students. This way, students will
have an easier time understanding what CAPS stands for in an efficient and timely
manner. Additionally, if the application process were made more transparent for students,
they would have an easier time enrolling, and would most likely get more out of the
process.

This solution would be effective in that it would improve the way students feel about the
application process and the experience as a whole. In addition, this solution would have
little to no monetary cost because an Indiana University UITS faculty member would be
able to assist CAPS in improving the overall functionality of the website. However, our
group did not receive positive feedback for this solution from Nancy Stockton because
she feels as though the process works very, very well. Students, on the other hand, feel
very passionately about making this change possible because they find the website and
screening process to be CAPS main issue. Ultimately, CAPS should set out to please
students on Indiana Universitys campus.

Solution 2: Hire more psychologists and psychiatrists

After interviewing Nancy Stockton, we learned that the biggest problem CAPS is
currently facing is the lack of sufficient resources, especially psychologists and
psychiatrists. In fact, the ratio of full-time medical staff to students is about 1 to 2,200. In
other words, for every 2,200 students on Indianas campus, there is only one available
medical doctor. For this reason, many students who are in need of psychological attention
are given wait times averaging anywhere from about ten days to five or six weeks,
depending on the severity of the situation. In many cases, waiting this extensive period of
time can be very deteriorating for ones psychological condition. Nancy Stockton
believes that the CAPS office is understaffed and hiring more employees would allow
CAPS to fit more students in for appointments. Nancy Stockton and the rest of her staff
are hoping for a slight dollar increase in order to hire more mental health professionals.

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I feel that we are understaffed and

that more employees would help allow
us to get more students seen. We are
all hoping for a slight dollar increase
to get more staff. Nancy Stockton

Visual 2

This solution is effective because it would result in more students getting help in a
timelier manner. Little to no students will be left with absolutely no psychological help,
which will greatly improve the attitude students around campus hold toward CAPS. This
solution would be costly in that hiring another psychologist would cost about $74,000,
while hiring another psychiatrist would cost about $182,000. In order to make a
significant difference in the way the process works, at least six new
psychologists/psychiatrists would need to be hired. This would result in the ratio of full-
time medical staff to students going from 1 to 2,200 to 1 to 1,760. This would make a
significant difference in the amount of students being seen, and this solution received
very positive feedback from CAPS faculty. Students around campus also agreed that
hiring more medical personnel would make a significant difference in the speed of the
process and the average wait time.

Solution 3: Host an enrollment fair on campus to expand awareness of CAPS

existence and services

Nancy Stockton shared with the group that she believes CAPS does a good job
advertising its services. Messages are constantly being sent out to students and
informative flyers are posted everywhere around campus. However, she believes it is
difficult to truly get the word out because the school has various messages being sent out
all the time. Students are, in a sense, being bombarded with too many different
opportunities all at once. Oftentimes, students receive an email and either send it straight
to their trash, or they skim through it too quickly and then send it to their trash. Other
students simply walk by the flyers and the information goes in one ear and out the other.

We propose hosting an informational enrollment fair on campus. This would be a very

beneficial way to advertise the CAPS services to those who may be interested. An event
held on campus that students can physically attend to find out more information about
CAPS will ultimately be more beneficial than just another email received or just another
flyer posted around campus. In addition, students will be able to fill out the CAPS
application in person before leaving the fair. As a result, students can get one-on-one help
with anything they need, whether it be navigating the application or figuring out whether
CAPS is right for them. At this point, the students who attended the fair will be done with
all of the pre-requisites, and all they will have to do is just wait to be seen by a
psychologist. This solution takes away a lot of the stress and pressure that may come with
having to do the application process alone with no resources or guidance. Our group
received very positive feedback from the faculty at CAPS, and they expressed excitement
about the idea. They claimed that they would be on-board with making this enrollment

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fair possible and that they would be willing to set the necessary resources aside. As for
resources, this enrollment fair will cost an average of about $250, and it should be held
twice a semester. Additionally, a space where the event can be held will need to be made
readily available. Students seemed to be excited about the idea and expressed interest in
attending at least one of these enrollment fairs.

Conclusion
Indiana University strives to give its students the best mental health care that can be
provided. After completing our research, we came up with various solutions that would
improve the CAPS screening process. We considered solutions including revamping the
CAPS website and the application process to make them more transparent for students,
hiring more psychologists and psychiatrists, and hosting an enrollment fair to raise
awareness of CAPS existence. While all of the solutions have merit, some clearly stand
out more than others. Criteria considered to find the best possible solution were
effectiveness, cost of implementation, and faculty and student feedback.

Although solution 2 may be the most expensive, we believe it to be the most effective in
that it received positive feedback from both CAPS faculty and students around campus.
Regarding solution 1 the faculty at CAPS believes that the website is working fine as is,
students seemed to be intrigued by the idea of revamping the CAPS website. This
solution requires little to no financial aid; therefore, it is an easily employed and
financially viable resolution that will please the specific student population. While
solution 3 received positive faculty and student feedback, we do not believe it to be the
most efficient way to solve the problem at hand.

All facts considered, the best way to accomplish these goals is by utilizing a combination
of solutions 1 and 2. The combination of solutions 1 and 2 would require adding more
full-time psychologists and psychiatrists to CAPS, as well as editing the CAPS website.

Recommendations
In order to improve the overall screening process, we propose the combination of
solutions 1 and 2. The combination we mentioned above would include hiring more full
time staff and fixing the issues students have with the website. Below, one can find a list
of steps that must be taken in order to achieve the goals we have outlined.

Revamp the CAPS Website and the Application Process to Make Them
More Transparent for Students
Communicate with UITS to express desired improvements
Discuss timeframe of construction and completion of website
Determine the amount of money that will need to be set aside in the budget
Send out notice to campus letting students know the website will be down for a
brief time period for construction
Conduct usability testing
Launch new website

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Hire More Psychologists and Psychiatrists

CAPS must pitch the need for more room in the budget to allow for new staff
members
Interview possible candidates to fill positions
Hire and train new faculty members to maximize efficiency
Open more appointment slots due to increased capacity

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Appendix A
Indiana University CAPS Survey

1. Have you ever heard of the Counseling and Psychological Services (CAPS)?
Yes

No

2. Have you ever used CAPS?

Yes

No

3. If you wanted/ needed to use CAPS, would you know where and how to
apply?
Yes

No
60% of respondents claimed that they would not know where and how to sign up
for a CAPS session

4. Do you know anyone who has used CAPS?

Yes

No

5. If you were struggling with stress, anxiety, and/or depression, would you turn
to CAPS?
I would go strai ght to CAPS

I would avoi d goi ng to CAPS

6. If you have ever used CAPS at IU Health, did you find the process to be
lengthy or difficult?
I have never used CAPS

No, the process was strai ghtforward

Yes, the process was lengthy and di ffi cult

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80% of respondents who have used CAPS claimed the process to be too lengthy
and difficult

7. On a scale of 1-10, how stressed/anxious do you typically feel? (1 being the

least stressed & 10 being the most stressed) *This can be related to
schoolwork, friends, family, finance, etc.
80% of respondents fell into the range of a 7-10 stress/ anxiety level

8. On a scale of 1-10, how depressed do you typically feel? (1 being not

depressed at all & 10 being very depressed)

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Appendix B
Interview with an Indiana University student who has gone
through the screening process (this student prefers to remain
anonymous)

Q: What was the screening process and the linkage to the care system like? Was it
effective?
A: For the most part the screening process is rather straightforward. You call the office
provided on the health center website and are then directed to a scheduler who designates
a time for you to meet with an intake member of the CAPS staff. These appointments can
vary in terms of how soon you can be seen; although i am told they also have a walk in
option for those experiencing very serious psychological distress. At the intake -which
lasts about 30 minutes- you meet with your intake member and basically explain why
you're there. You don't see this person again, however, as once your intake session is
finished you return to the front desk (along with the intake individual who talks to the
head receptionist) and proceed to make a follow up appointment. In my many
experiences at caps is have found it is not unusual for the earliest that this follow up
appointment can be usually a week to ten days at least from the date of intake. Moreover,
when you do return, you are then presented for the first time to your therapist: many of
whom I have been told are graduate student level interns studying at IU themselves.
This appointment -which is an hour long- requires you to basically re-explain all
that you explained previously to the intake member which is rather inefficient and
requires that the psychological issues that one is experiencing be the same a week after
intake that they were on the day of the first appointment: for obvious reasons this is quite
often not the case.
In any event, if one wishes to see a psychiatrist regarding medication -whether
this be regarding some that they are already taking or some that they believe would be
helpful- they can only do so on the recommendation of the therapist who they see during
the second meeting.

Q: Did the services offered by CAPS allow you to continue your academic experiences
at Indiana University?
A: All of this being said, because of the extended periods of time required by the
system in place at CAPS, in addition to the disconnect between all of the different
relevant practitioners that one must see; I would have to say the system is not entirely
efficient especially for more serious psychological and mental illness situations.
Moreover, although there have been a number of times that CAPS have assisted me in my
academic endeavors, the entire process and the length of time required did play a role in
my ultimate medical withdrawal from IU, because I genuinely believed the process of
going through everything I had to in order to be helped would take so long that I had
much better chances seeking help elsewhere.

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Appendix C
Interview with Nancy Stockton, director of Indiana University
Counseling and Psychological Services

Q: How many psychologists/psychiatrists are there on staff? Is this enough in relation to

the size of Indiana Universitys campus?
A: We have 8 psychologists and 2 psychiatrists, Yes, I think that more staff is required.
We have a full time staff of about 24. This is a ration of 1 to 2,200 workers to students.

Q: How long does it typically take for a student to be seen by someone once they have
expressed interest/applied online? (In other words, what is the typical timeframe that
students wait to be seen?)
A: It depends on the time of the semester. If someone is in crisis, we try to see them
immediately, but this doesnt always work out. If someone is at a called level 2, meaning
that they may have a history of depression but are not actively suicidal, this could take
anywhere from 3-6 weeks. If someone is at a level 3, it takes about 2-3 weeks. We are
usually booked until the end of finals week.

Q: Have you ever heard any complaints (from a student) about the waiting time to be
seen by a doctor or about the application itself?
A: Yes, we tend to get complaints from parents. We want to keep fees as low as
possible, but one of the costs due to this leads to fewer resources.

Q: On average how many appointments do you have (how many students do you see) a
day? A week?
A: 4,000 students a year, and about 30,000 visits a year.
Q: Do you think you are seeing enough students a day/week/month, or do you think it is
a possibility to fit more students/appointments into your schedule?
A: We are booked through most of the year, and we see as many students as we can fit
in with the limited staff that we have. I definitely think we could fit more students in if
we had more medical personnel on staff. Walk-ins usually dont occur until break
periods, since we are booked all through the semester.

Q: Do you think CAPS could benefit from/improve its services by hiring more
psychologists/psychiatrists?
A: Yes, I feel that we are understaffed and that more employees would help allow us to
get more students seen. We are all hoping for a slight dollar increase to get more staff.

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Q: What part of the application process do you think needs the most improvement?
A: The biggest problem is the need for more resources. The application itself could
possibly be made quicker and more transparent for students so that it is easier to follow.

Q: Do you believe that there is a greater prevalence of mental illness on campus than
what is known? In other words, do you think there are a significant number of students
with depression and/or anxiety who are keeping to themselves?
A: Yes, I believe that there are many students that should seek help but choose to keep
it to themselves.

Q: What do you believe to be the biggest challenge faced by college students in terms of
mental illness?
A: Some form of anxiety or panic brings the most people to CAPS (used to be
depression). This has to do with the stressors of the society, background of students
minds, future jobs, economy, climate change, etc. Social media leads to a lot of stress
within our generation. Having to contesting keep checking. Competitiveness in this day
of age.

Q: Do you think that CAPS does a good enough job of letting students know that help is
available, if need be?
A: We advertise and make sure IAs know about us. I feel that we send messages out
all the time. Its hard since IU has so many messages being sent out all the time. We do
our best to get the word out, but we could definitely do better.

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References
College Students. (2012). Retrieved December 05, 2016, from
http://www.stress.org/college-students/

Gruttadaro, D., & Crudo, D. (2012). COLLEGE STUDENTS SPEAK: A SURVEY

REPORT ON MENTAL HEALTH. National Alliance on Mental Illness.
Retrieved October/November, 2016, from https://www.nami.org/About-
NAMI/Publications-Reports/Survey-Reports/College-Students-Speak_A-Survey-
Report-on-Mental-H.pdf.

Indiana University Bloomington. (n.d.). Retrieved December 05, 2016, from

http://healthcenter.indiana.edu/counseling/staff/index.shtml

Mistler, B. J., Ph.D., Reetz, D. R., Ph.D., Krylowicz, B., Ph.D., & Barr, V., Ph.D. (2012).
The Association for University and College Counseling Center Directors Annual
Survey. The Association for University and College Counseling Center Directors.
Retrieved October/November, 2016, from
http://files.cmcglobal.com/Monograph_2012_AUCCCD_Public.pdf

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