Informed Consent for Therapy Agreement
Please read through the following informed consent agreement. What follows is a basic understanding between you and your JustUs Behavioral Health therapist.
These are the responsibilities and obligations of your therapist, and expectations of you as the client. This document contains important information about our professional services and business policies. Please do not sign the informed consent until you completely understand and agree to all aspects. If you have any questions, please bring this form to your next session, so you and your therapist can go through the document in as much detail as needed. When you sign this document, it will represent an agreement between us.
Treatment at JustUs Behavioral Health is voluntary, so you may terminate at any time without penalty. Counseling requires a commitment of time, money, and energy, so we want you to be thoughtful about your decision for a therapist. In the first couple of sessions, we hope you will decide whether your therapist is right for you. If you think it is a good match, we hope you will tell us! If it is not a good match, then we will be happy to assist you in finding a new therapist.
All clients are expected to show up to appointments on time, prepared to focus on and discuss therapy goals and issues. All clients are expected to be open and honest, so we can assist you with your goals. For therapy to be successful, you are encouraged to work on things we talk about both during our sessions and between sessions.
Your therapist will be prepared at the designated time, (barring emergencies), and will be attentive and supportive in meeting the therapy goals and do everything possible to assist you in achieving a greater sense of self-awareness and work toward helping you resolve problem areas.
Although the majority of people do get better in therapy, some get worse. Oftentimes, people get worse before they get better! We cannot guarantee therapy will result in: becoming happier, saving a relationship, stopping drug abuse, becoming less depressed, and so forth.
Risks of Therapy:
Just as medications sometimes causes unexpected side effects, counseling can stimulate painful memories, unanticipated changes in your life, and emotions like sadness, guilt, anger, frustration, loneliness, and helplessness. In some cases, client’s symptoms become worse during the course of therapy, occasionally necessitating hospitalization. Another risk of therapy is that throughout the process of therapeutic change it is not uncommon for clients to reach a point of change where they may feel they are different and no longer able to be the same person they were upon entering therapy. At times these feelings can be unsettling.
Benefits of Therapy:
The benefits of therapy can include: a higher level of functional coping, solutions to specific problems, new insights into self, more effective means of communicating in relationships, symptomatic relief, and improved self-esteem.
Alternatives to Traditional Therapy:
Can include: stress management, twelve step programs, peer self-help groups, bibliotherapy, and support groups.
Credentials and Qualifications:
All mental health counselors at JustUs Behavioral Health are either fully licensed mental health professionals by the state of Minnesota or clinical trainees who are providing services under the supervision of a board approved supervisor.
Counseling Approach & Theory:
JustUs Health envisions a Minnesota where people from diverse gender, sexual, and cultural communities experience health and wellness in powerfully inclusive environments. JustUs Health values inclusion, equity, innovation, compassion, integrity, professionalism, and excellence. JustUs Behavioral Health is committed to providing comprehensive, integrative mental health, sexual health, and chemical health services from a trauma-informed, attachment-based, risk-reduction, and sex-positive perspective. We promote the health and well-being of our clients while also celebrating the diversity of our community. Our practitioners use a wide array of researched therapy models to meet the unique needs of each client.
In keeping with standards of practice, your therapist may consult with other mental health professionals regarding care and management of cases. The purpose of this consultation is to ensure quality of care. If your therapist is a clinical trainee, s/he is required to consult with a clinical supervisor who is approved by their licensing board to provide clinical supervision. The clinical supervisor will have access to your mental health record and may sign some documents.
Sessions and Length of Therapy:
Once we have agreed to work together, we will usually schedule one appointment every 1-2 weeks at a time we can agree upon. Sessions are usually scheduled for 45 to 60 minutes. Length of therapy is quite variable based on client motivation, number and severity of issues to resolve, and work efforts outside of therapy sessions. Some people get their needs met in 5 to 10 sessions, others find it helpful to continue in therapy for much longer.
Children in the Waiting Area:
We are not able to assume responsibility for the care of children during therapy sessions. While we value children, their presence in a session is generally disruptive to the counseling process, and we respectfully request you arrange for their care so you may come alone. If you have difficulty arranging child care elsewhere, please talk with your therapist.
Confidentiality and Privilege:
The information and content shared in therapy will remain confidential, except as noted in the next section: Exceptions to Confidentiality and Privilege. Your information will not be shared with anyone without your written consent. Your information is also privileged, which means that your therapist is free from the duty to speak in court about your counseling unless you waive that right, or a judge orders it.
Exceptions to Confidentiality and Privilege:
As a mandated reporter in the state of Minnesota your therapist is legally obligated to violate confidentiality under the following circumstances:
- When the therapist has reason to suspect that the client has been, or is currently, involved in the abuse or neglect of child
- When the therapist has reason to suspect that the client has been, or is currently, involved, in the abuse or neglect of vulnerable adults
- If a client is pregnant and taking street drugs
- If the client reports sexual misconduct by another counselor
- If a client is a serious danger to themselves, i.e., if suicidal
- If a client is a serious danger to someone else, i.e., if homicidal
- If the courts order copies of records
- Another time when confidentiality has limitations is for minor clients. Parents and guardians have legal right to access a minor client’s records
- Minor clients do have the rights to complete confidentiality in obtaining counseling for pregnancies and associated conditions, sexually transmitted diseases, and information about alcohol or drug abuse
Ethical and Legal Guidelines:
Your counselor is bound by law to follow the professional code of conduct for his/her license. If your counselor is a clinical trainee, s/he is expected to follow the same code of conduct as the license s/he is seeking. The codes of conduct are posted in each clinical supervisor’s office and is available upon request from the Director of Clinical Services.
Additionally, each counselor is expected to behave within the code of ethics for their professional association. The professional associations represented at JustUs Behavioral Health include: National Association of Social Workers; American Counseling Association; NAADAC: The Association for Addiction Counselors, and the American Association of Sexuality Educators, Counselors and Therapists.
The laws and standards of our profession require that we keep records of our clients. You are entitled to receive a copy of the records unless we believe seeing them would be emotionally damaging, in which case we will send them to a mental health professional of your choosing. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. We recommend you review them in your therapist’s presence, so we can discuss the contents. All client records include: a data sheet filled out prior to therapy, a chronological listing of appointments and fees, a copy of signed releases, copies of any correspondence regarding your case, a copy of the signed informed consent packet materials, and a copy of progress notes. All records will be maintained by your therapist in a secured area for a period of seven years following the last date of service.
Counseling and Records for Minors:
If you are under 18 years of age, please be aware that Minnesota law provides your parents the right to review your treatment records as well as obtain information from us about your diagnosis, progress, and treatment. It is our policy to request an agreement from parents that they agree to avoid unnecessary review of records and involvement in your treatment. If they agree, we will only provide them general information about our work together, unless we think there is a high risk that you will seriously harm yourself or someone else. In this case, we will notify them of our concern.
In the course of operating our behavioral health clinic we contract with various external vendors such as information technology (IT), claims clearinghouse, and an electronic health record (EHR) vendor. In all these cases we have a HIPAA business associate contract in place with our vendors. This means they understand the federal HIPAA guidelines for confidentiality and agree to abide by those regulations set forth and maintain the same level of confidentiality that healthcare professionals are bound to in the event they should encounter patient information. Our claims clearinghouse and Electronic Health Record (EHR) is used to submit medical claims electronically and maintain client records. In both cases, bank level security and encryption are used to protect client information. Their systems are also electronically automated and vendor support representatives are only accessed if a data input error occurred. Support staff of the claims clearinghouse and EHR vendor have restricted access and are not able to access patient narrative notes. Our EHR vendor, like most EHR vendors, does have authority to use de-identified patient information. They do this in compliance with HIPAA guidelines to ensure any data extracted for research purposes cannot be identified to a client. If you have any concerns or further questions, please talk to our HIPAA Compliance Officer.
Disputes and Complaints:
Any disputes or complaints that cannot be resolved between the client, therapist, and the JustUs Behavioral Health Director of Clinical Services can be directed to the respective Board coinciding with your clinician’s licensure: Minnesota Board of Social Work or the Minnesota Board of Behavioral Health and Therapy.
All clinicians perform an initial diagnostic session which is more expensive than follow up therapy sessions. A fee schedule for services can be provided at your request. Please understand we are required to collect all insurance co-pays at the time of service.
You should be aware that most insurance companies require you to authorize us to provide them with a clinical diagnosis for benefits to pay for services. Sometimes we are required to provide additional clinical information such as treatment plans or summaries, or copies of the entire record (in rare cases). This information will become part of the insurance company files and will probably be stored in a computer. Although all insurance companies claim to keep such information confidential, we have no control over what they do with it once it is in their hands. In some cases, they can share the information with national medical information databanks. It is important to remember that you always have the right to pay for services yourself to avoid the potential problems described above. Please keep us informed of changes in your financial status and insurance or medical assistance eligibility. You may be responsible for charges incurred if your coverage has changed or lapsed and you do not inform us in advance.
We are often not immediately available by phone. When we are unavailable, you may leave a voice message and we will make every effort to return your call the same day you called, with the exception of weekends and holidays. If you are difficult to reach, we encourage you to leave us times when you will be available.
Emergency & Interruption of Therapy:
In the event of any mental health or substance use emergency, we encourage you to call 911. When your regular therapist is on vacation or plans to be unavailable for a brief period of time, we will provide you with the name and number of another therapist with questions or come in to see as needed. In the event of a longer interruption of therapy we will make appropriate referrals as needed.
You or the therapist may end therapy at any time. Your voluntary involvement allows you to discontinue at any time. If you desire additional counseling your therapist will provide you with a referral competent to address your issues.