INFORMED CONSENT

When we begin working together it is my responsibility to be mindful of the day you will end therapy. I am planning for the day that you are prepared to move forward living your life without my support. And it is my goal to get you here as quickly and safely as possible. If I observe indicators we are not moving forward It is my commitment to you to keep you on track and in the direction of your goals. Good clinical work can take time. And the more work you have to do, the longer it can take. There is no rule that you have to do all that work in therapy.  As your therapist I am held to an ethical standard which dictates my role and demands that therapy be beneficial to you in some way in order for it to continue. From the start it is my duty to assist in preparing you for gaining insight, skills and strategies to move forward independently, confident in continuing the work. Starting counseling is a major decision and you may have many questions. This document is intended to inform you of my background, confidentiality, and how to handle emergencies should one arise. If you have other questions or concerns, please ask. If at any time you feel our work together is no longer helpful and you wish to change counselors or stop using my services, simply let me know as I hope to help in anyway and it is understandable that not every counselor and client are a match. Individual, couples and family sessions are limited to 45 minutes.

IDENTIFYING INFORMATION: 

Lindsay Powelson, MA, LPC. Licensed through the State of Missouri Committee for Professional Counselors since 2006  #2004024728 MO.  Master of Arts degree earned in 2004 from Lindenwood University in Professional Counseling. National Board Certified Counselor (NCC). Certified Clinical Trauma Professional Level II (CCPT-II). A few examples of experience include; mood disorders, trauma, grief, disordered eating, sexual intimacy challenges, GNC affirmative, public school systems, child protective services, Family Court system, long-term care organizations, adoption and foster care, infertility, LGBT, family and couples counseling. 

CONFIDENTIALITY:  

In order to fulfill the requirements set forth by the State of Missouri licensure board, full name, phone, DOB, Primary Care Physician name and contact information, your address as well as an emergency contact is necessary for my records. I will also need to verify your identity through a photo copy of your ID. This information and proof of identity is required to be submitted prior to our first session. 

Client information shared is confidential, except in the following circumstances.

• Mandated reporting of physical or sexual abuse and/or neglect.
• Threats of suicide or homicide.
• Cases where the clients signs a release of information.
• Information necessary for supervision or consultation.
• Information released as outlined in the HIPAA Notice of Privacy Practice 
• Those required by law.

In the event of concerns regarding your safety as a client or the safety of others, you are authorizing me to use the emergency contact information you provide as well as the primary care physician contact as I find it necessary. 

There are risks and benefits to tele-mental health services. 

The risks:

• Although most communication will be in real time it is important to note that in the event we would send typed messages, I cannot see nonverbal cues that I would see if we were face to face. This means I may not recognize how you are feeling unless you specifically tell me. This also means that messages from either of us to the other could convey a tone that isn’t intended. We can minimize this by asking for clarification when feeling uncertain.
• There is a risk of technology failure, and sometimes at the worst possible time. We can  minimize this by having a plan for what to do if this happens.
• If someone has access to your email or the device you use to login sessions, there is a chance that person could access our communications.
• The telehealth platforms used are HIPAA-compliant, however, as with any technology, there is always a risk of unauthorized access or data breach. If that ever were to happen, you will be informed.

EMERGENCY SITUATIONS: 

I am available Monday-Friday 9 am - 3 pm CST. I will be responding to any messages within 24 hours.  Please note if you message over the weekend I will respond the following Monday. Holidays may also impact availability. I will notify you if I will be on vacation or away. Contact between consultations will be limited unless otherwise noted. If you feel there is something of significance to discuss please schedule an appointment. Contact information is not shared with the intent of communicating between sessions. 

DRUG/ALCOHOL USE:

Coming to treatment intoxicated on alcohol or drugs impairs ability to participate in treatment, whether it is for an initial counseling session, assessment or individual treatment. If it is determined that a client is under the influence the session will be rescheduled. Forming a therapeutic alliance is based on the mutual understanding that services will take place with both parties sober. If it is determined that substance use is a factor at the time of the session the session cannot be held, the client will be charged for a no-show session.

*Please understand that the services provided through Mindful Solutions Behavioral Counseling LLC,  are not intended for crisis situations or urgent needs. In a crisis situation, you will need to call 911 or local emergency services, or visit the nearest emergency room.  If you feel you need crisis services the services offered by this clinician will not meet those needs. If this clinician determines that you need a higher level of care you will be notified and services with this clinician will no longer be available. 

NO SHOW POLICY:

People are becoming busier and some are adjusting to new daily routines. In recognizing this,  scheduling can become a problem. This is a gentle reminder for those who may not be aware that it is customary to let your clinician know when you can not make an appointment within 24 hours. The first "no show" will be billed at 1/2 the session rate.  After the second “no show” sessions will be billed at the full session rate.  No shows are described as not communicating you will miss your appointment and you are not present at the time of the appointment.  After a third consecutive missed appointment any further scheduled sessions will be cancelled as this limits appointment options for other clients. I recognize this policy can be a challenge and appreciate your understanding.

COORDINATION OF TREATMENT: 

It can be beneficial to inform your primary care physician and other healthcare providers that you are working with a counselor. 

NOTICE OF PRIVACY PRACTICES AND CLIENTS RIGHTS: 

https://privacyrights.org/consumer-guides/health-privacy-hipaa-basics

GOOD FAITH ESTIMATE:

A Good Faith Estimate is an estimate of the total expected costs of non-emergency healthcare items or services. Intends to offer predictability & transparency in how much clients will be charged for healthcare services prior to their appointment. Includes all regularly scheduled appointments (i.e. therapy sessions). You will receive the GFE with billing. 

*If you or someone you know needs mental
health help, text "STRENGTH" to the Crisis
Text Line at 741-741 to be connected to a
certified crisis counselor.*