INFORMATION DISCLOSURE STATEMENT
Therapy/coaching is a relationship that works in part because of clearly defined rights and responsibilities held by each person. This framework helps to create the safety to take risks and the support to become empowered to change. As a client, you and your child have certain rights. There are also certain limitations to those rights that you should be aware of. As a therapist/coach, I have corresponding responsibilities to you.
My Responsibilities to You
CONFIDENTIALITY With the exception of certain specific exceptions described below, you have the absolute right to the confidentiality of your treatment. I cannot and will not tell anyone else what you have told me, or even that you are a client in treatment with me without your prior written permission. Under the provisions of the Health Care Information Act of 1992, I may legally speak to another health care provider or a member of your family about you without your prior consent, but will do so only when the situation is an emergency. You may direct me to share information with whomever you choose, and you can change your mind and revoke that permission at any time. You may request anyone you wish to attend a session with you. You are also protected under the provisions of the Federal Health Insurance Portability and Accountability Act (HIPAA). This law insures the confidentiality of all electronic transmission of information about you. Whenever I transmit information about you electronically it will be done with special safeguards to insure confidentiality. If you elect to communicate with me by email at some point in our work together, please be aware that email is not completely confidential. All emails are retained in the logs of your or my internet service provider. While under normal circumstances no one looks at these logs, they are, in theory, available to be read by the system administrator(s) of the internet service provider. Any email I receive from you, and any responses that I send to you, will be electronically filed in an encrypted file as part of your treatment record. In all email correspondence I will be mindful of the confidentiality of the content. If I feel the issue is better discussed in person or by phone due to confidentiality issues I will suggest we make an appointment to speak.
MINOR AGREEMENT I understand that the normal procedure for discussing issues that are in my child’s/children’s therapy will be joint sessions including my child/children, the therapist, and me and perhaps other appropriate adults. If I believe there are significant health or safety issues, I will contact the therapist and attempt to arrange a session without my child/children present.
Similarly, when the therapist determines that there are significant issues that should be discussed with parents, every effort will be made to schedule a session involving the parents and the child/children. I understand that if information becomes known to the therapist and has a significant bearing on the child’s/children’s well-being, the therapist will work with the person providing the information to ensure that both parents are aware of it. In other words, the therapist will not divulge secrets except as mandated by law, but may encourage the individual who has the information to disclose it for therapy to continue effectively.
The following are legal exceptions to your right of confidentiality. I would inform you of any time when I think I will have to put these into effect.
1. If I have good reason to believe that you or child will harm another person, I must attempt to inform that person and warn them of your intentions. I must also contact the police and ask them to protect your intended victim.
2. If I have good reason to believe that you are abusing or neglecting a child or vulnerable adult, or if you give me information about someone else who is doing this, I must inform Child Protective Services within 48 hours and Adult Protective Services immediately.
3. If I believe that you or child is in imminent danger of harming yourself/yourselves, I may legally break confidentiality and call the police or relevant crisis team. I am obligated to do this, and would explore all other options with you before I took this step. If at that point you were unwilling to take steps to guarantee your safety, I would call the crisis team.
4. If you tell me of the behavior of another named health or mental health care provider that informs me that this person has either (a.) engaged in sexual contact with a patient, including yourself or (b.) is impaired from practice in some manner by cognitive, emotional, behavioral, or health problems, then the law requires me to report this to their licensing board at the TX Dept. of Health. I would inform you before taking this step.
If you are my client and a health care provider, however, your confidentiality remains protected under the law from this kind of reporting.
Record-keeping. I keep very brief records, noting only that you have been here, what interventions happened in session, and the topics we discussed. If you prefer that I keep no records, you must give me a written request to this effect for your file and I will only note that you attended treatment in the record. Under the provisions of the Health Care Information Act of 1992, you have the right to a copy of your file at any time. You have the right to request that I correct any errors in your file. You have the right to request that I make a copy of your file available to any other health care provider at your written request. I maintain your records in a secure location and they are not open to other persons.
