The Flexible Care Model (FCM) is a mental health treatment delivery framework created to resolve system bottlenecks and eliminate waitlists, primarily for use in university counseling centers. Developed over a ten year span across multiple institutions, the model draws on common factors research, multicultural psychology, and urgent care medicine to replace traditional appointment structures with rapid access and customizable care. Core features include same-day access, variable session lengths (20–30 minute concise sessions), immediate goal-focused counseling, and tailored follow-up pathways. Many universities across the US have implemented some or all aspects of the FCM, ranging across small private colleges, highly selective elite universities, and large state institutions.
For a comprehensive deep dive into the theoretical framework, multi-year outcome data, and complete operational mechanics of the Flexible Care Model, explore the original peer-reviewed publication. Download the complete article below to review the full research, methodology, and data sets. The rest of the page is an overview and companion piece to the article.
National Campus Trends & Demographic Context
Traditional university counseling center practices such as scheduling appointments up to several weeks in advance, conducting full intake assessments before treatment, and offering weekly 50-minute therapy sessions have become strained under increasing service demand.
- Cyclical Distress: Longitudinal National College Health Assessment (NCHA) data shows cyclical fluctuations in student-reported sadness, depression, and suicidality over time rather than a simple linear progression, underscoring the need for adaptable service capacity. There was an upswing between 2009-2019, and recent data shows it may have peaked during the pandemic and is moving back toward the mean.
- Elevated Demand: Surge in student help-seeking has led to longer wait times and reduced session frequencies across institutions. Additionally, destigmatization campaigns encourage students with developmental, routine, or sub-clinical concerns to seek care, driving demand alongside complex clinical presentations.
- Shifting Student Demographics: Per National Center for Education Statistics (NCES) data, students of color comprise ~44% of U.S. college enrollment (up from 18% in 1976), 37% of students are over age 25, and international enrollment continues to grow. Most counseling center systems were designed when the demographics of their institutions was different than it is today. These shifts require culturally responsive systems of care rather than continuing with care models that may not match current students.
Traditional Counseling Systems
Traditional university counseling center delivery models were built on an outpatient medicine / private-practice framework designed for lower-volume, longer-term therapy. As student enrollment and help-seeking behaviors have expanded over the decades, these operational structures have created systemic bottlenecks across campus mental health systems. While this has provided high levels of care for the students that ultimately get access to the center, it also has predictable problems related to wait times, students who cannot access care, and provider burnout. Some aspects of the traditional model to note before going further are:
- Advanced Scheduling: Most counseling centers require students to schedule meetings and plan care in advance except for urgent situations related to self-harm and other serious situations.
- Intake as First Session: Legacy systems require every student to have a semi-extensive diagnostic intake assessment before receiving treatment, focusing heavily on history gathering and a range of other topics rather than addressing their immediate presenting concern. A “triage” step may also be part of the intake process as well.
- Traditional 50-Minute Sessions: Operating exclusively on 50-minute appointment blocks limits clinical scheduling flexibility, treating all student concerns as requiring identical session length allocations regardless of acuity, goals, or preferences.
- Waitlist & Access Delays: Students routinely face multiweek delays between initial contact, intake, and their first actual therapy session, leaving distress relatively unaddressed academic windows.
- Clinician Burnout & Moral Injury: Staff are forced to carry ever-growing caseloads and manage static waitlists, leading to severe professional burnout without improving overall population-level access.
- Common System Solutions & Boundaries: Counseling centers use several strategies to alleviate the challenges, which include referring students off campus, adding staff, using session limits, triage screenings, moving to Stepped Care, increasing group therapy, and contracting with third-party services to manage overflow. A great resource on this is Shefet (2017).
Call for Improvements
There have been efforts and calls for improvements to these systems as early as the 1990s, when their limitations were first being discussed in the literature. Some examples include:
- Kirk et al (1971): In a paper that became the foundation for the IACS standards, he wrote: “A major responsibility of any Counseling Service is to be alert to the changing needs of its university community. To be responsive to them, the Counseling Service must maintain an attitude of thoughtful experimentation and careful innovation: conceptual, strategic, and programmatic.” (p. 586)
- Bishop (1990): “Clinging to a traditional counseling and therapy model may prevent a counseling center from engaging in preventative and developmental roles and, even at that cost, may still not be an effective way at responding to the increasing demands placed on it.” (p. 411).
- Brinson & Kottler (1995): “Because minority clients respond better to less structured and more informal settings, it can be assumed that the usual counseling model of a 50-minute “hour” by appointment will be less effective than more flexible alternatives. Thus, drop-in centers that provide alternative settings in which counseling can occur should be developed and implemented by staff members.”
- Chronicle Of Higher Education (2020): A major report echoed these calls for change and made recommendations. Aspects of the Flexible Care Model were featured throughout the report, and their first major recommendations was to “Create Flexible Treatment Models” (p45).
Philosophical & Clinical Foundations
The Flexible Care Model re-evaluates traditional mental health delivery systems by synthesizing established psychological theories, medical paradigms, and psychotherapy literature. These foundational frameworks justify moving away from rigid 50-minute hours toward dynamic, client-centered care.
- Common Factors Research: Demonstrates that effective psychotherapies share core curative elements that include a healing relationship, an therapeutic setting, and a shared rationale for change (Frank, Frank, & Wampold 2025). This provides the theoretical basis for adapting therapy into non-traditional structures and shorter durations.
- Multicultural Psychology: Recognizes that mental health help-seeking beliefs are culturally bound. Eurocentric models requiring planned, formal 50-minute appointments can impede service utilization. Flexible, drop-in, or same-day options align better with diverse help-seeking preferences.
- Urgent Care Medicine: The FCM adapts the medical urgent care paradigm to some extent, providing on-demand scheduling, immediate targeted interventions, and as-needed return visits as the default operating model for counseling centers.
- Psychotherapy Dosage Literature: Classic dose-effect research (Howard et al., 1986) demonstrates a logarithmic relationship between session count and client improvement, with approximately 50% of therapeutic gains occurring within the first 8 sessions. Front-loading high-quality intervention at the exact moment of client request maximizes this early therapeutic momentum. The intake interview or other delays can reduce this impact, leading clients to require more sessions than they otherwise would.
Core Components of the Flexible Care Model
Restructuring counseling center operations requires a coordinated transformation across four interconnected pillars. Together, these features replace traditional system components with more immediate access, flexible session lengths, and integrated care pathways.
1. Same-Day Access
Mechanics: Students contact the center on the day they wish to be seen to reserve a same-day appointment, eliminating the need for more advanced planning, getting care as close to the first moment they reach out as possible, and avoiding potentially chaotic walk-in bottlenecks.
Sandwich Semester Structure: Centers utilize “all same-day” or “rapid access” booking during initial weeks (weeks 1–3) and final exam periods (weeks 14–16) when demand spikes. Mid-semester weeks transition to a hybrid mix of scheduled follow-ups and reserved daily same-day slots.
Provider Continuity: All clinicians reserve 1–2 same-day slots daily, allowing returning clients to reconnect with their primary provider as needed.
2. Variable Session Lengths & Concise Sessions
Concise Sessions (20–30 Minutes): All clients initiate care with a concise psychotherapy session (20–30 minutes). Concise sessions account for about two thirds of all visits in fully implemented centers. It’s important to note that the approach to these should be the same as a traditional 50-minute psychotherapy session. They should not be seen as “consultations” or something that is inherently lighter than psychotherapy, and there are examples of this from every major clinical tradition (psychodynamic, CBT/DBT/ACT, etc).
Clinical Efficacy: Comparative outcome literature (Bierenbaum et al., 1976; Turner et al., 1996) indicates 30-minute sessions produce clinical change and client satisfaction equal or superior to traditional 50-minute sessions.
Clinical Titration: Care is titrated up to traditional 45–50 minute sessions when concise meetings prove insufficient or when acute safety and case management demands require extra time. Traditional length seasons make up about one third of all meetings in fully implemented centers.
3. Goal-Focused Counseling
Immediate Treatment Focus: First appointments concentrate immediately on the student’s primary stated concern rather than completing lengthy psychosocial intake interviews.
Single-Session Stance: Drawing on the same principles as Single Session Therapy (SST) and campus Let’s Talk programs, providers treat every visit as a complete clinical encounter.
Parallel Assessment: Background and diagnostic data are gathered incrementally across sessions as clinically necessary. This allows providers to gather all of the same intake information over several session rather than front loading it all.
4. Customizable Follow-Up Pathways & Support
Whole-Campus Integration: Clinicians explicitly integrate academic advising, dean support, and wellness services into formal treatment plans, establishing a multi-departmental support network.
Flexible Menu Options: Follow-ups include concise appointments booked in advance, as-needed same-day visits, traditional 50-minute sessions, or group therapy.
AI Integration (maybe): While this hasn’t been a formal aspect of the FCM, it is clear that students are using AI tools to assist their mental health. Counseling centers should consider how student AI use can also factor into follow up care.
Staffing & Change Management
Successfully transitioning a counseling center away from legacy practice models requires proactive organizational leadership and staff engagement. Addressing clinician anxieties, building in system guardrails, and offering targeted skill trainings are vital for long-term success. Effectively managing this must include ways that the providers also see personal benefit in the structural change. Some of these include:
- Paced Reservation System: Centers limit weekly new-client intake slots per clinician to regulate caseload velocity and preserve follow-up capacity. Rather than fully scheduling the clinicians into all of their open time, the FCM relies on a more gradual increase in caseload as the semester goes.
- Workload Management: Total direct client contact hours per clinician per week should remain capped at 65%, which is the current IACS standard. System capacity expands entirely through visit structure and and creative workflows, not by expanding clinician bandwidth.
- Clinical Retraining in Single-Session Techniques: Successful adoption for more resistant providers relies on professional development focused on Single-Session Therapy (SST) frameworks, helping clinicians learn how to rapidly establish therapeutic alliance and set focused session goals within the briefer time periods.
- New Client Numbers: One of the most empowering aspects that leaders can use is allowing providers to manage their schedule more and avoiding punishing more efficient clinicians. For example, if all providers are expected to take 5 new clients per week, and Clinician A remains more traditional and uses 4 total hours in follow up sessions, and Clinician B uses 3 total hours for follow up sessions, then the additional free hour that Clinician B created should not be scheduled with additional clinical duties. There should also not be reductions in new clients for Clinician A. It should remain theirs to manage other aspects of their jobs. This incentivizes adoption and allows providers to have an increased sense of control.
Data & Case Study
The following data is presented in the FCM journal article linked above. It shows changes that occurred in the FCM implementation at a selective private university with around 10,000 enrolled students between 2017-2019. Further analysis is provided in the article.
- Wait Times: Average wait for a first appointment dropped from 2–3 weeks to 2–3 days during the initial rollout semester and remained stable over three years.
- System Capacity: Off-campus referrals fell from 32% (2017) to under 10% (2019). No-show rates decreased from 11% to 6%.
- Provider Differences: There was some variance between providers in how they practiced within the model. Some providers had higher percentages of concise sessions than others, which led to differences in number of students served per clinical hour (1.41-1.85), and variation between providers in clinical hours per week.
- Student Satisfaction: Spring 2018 post-session evaluations (n = 168) demonstrated high satisfaction across overall experience, meaningful help, and counselor rapport (means 2.83–2.88 on a 3.0 scale), with no statistically significant differences between concise and traditional sessions (p < .05).
- Clinical Outcomes (CCAPS Distress Index): Fall 2019 data (n = 619 / 3620 sessions) yielded an overall pre/post effect size of d = 0.32. Clients receiving only concise sessions (n = 352, / 1947 sessions) achieved a significantly higher effect size of d = 0.46, confirming substantial clinical improvement.
Recommended Starting Points
Institutions looking to transition toward a Flexible Care Model do not need to overhaul their entire operations overnight. Implementing a few high-impact structural adjustments allows counseling centers to test the model’s efficacy and build momentum while immediately expanding student access.
- Convert brief triage interviews into 30 minute concise goal-focused therapy sessions.
- Convert the final two weeks of the term entirely to same-day access scheduling.
- Reserve 1–2 daily non-urgent same-day slots per clinician schedule.
- Allow providers to offer 30 minute concise follow-up visits for returning clients.
Developmental History of the Model
If you made it this far, you may be curious about how this all developed. The idea for the Flexible Care Model didn’t just come to mind one day. It is really the result of 10+ years of experimenting with different approaches and listening to what the student’s experience was with them.
The origin was in my first job as a one-person counseling center for 4000 students at Washington State University Vancouver, where I as also the first full time clinician. Part of my job was to actually create the basic ways the center would operate. Because of that situation, I had to think creatively about seeing students and started experimenting with minor changes to session length, scheduling, and intakes. When student feedback on these alternative practices was positive I kept going with it, and eventually reduced what an intake was, did more 30-minute sessions (often at the necessity of the student’s schedule), and had more people return as-needed.
At my next campus with our staff of 4, we stopped doing intakes altogether and used a lot of 20-minute sessions focused on immediate help, which dramatically reduced wait time, improved access overall, and led to virtually no students being referred off campus. We did this while demand tripled in 4 years, from 8-24%.
When I arrived at Brown in 2017, our staff came together and decided on a set of solutions to implement the next semester, many of which were descendants of these previous systems and from student requests and collaborations. We launched what would later take the name of the Flexible Care Model that fall. The Brown News service wrote a story on this.
The model now is active in many counseling centers around the the US including at the center I manage with international providers at Minerva University, and it has also been adopted into areas of community mental health, private practice, K-12 schools, and beyond.
Contact me for more: willmeekphd@gmail.com