Trailhead Practice Policies and Informed Consent

 

Informed Consent

 

Therapy Services Risks and Benefits:

Our role is to assist you as a client, with issues regarding relationships, addictions, trauma, depression, anxiety, grief, and other challenges that impact you emotionally. Therapy often involves discussing difficult aspects of your life. During our work together you may experience uncomfortable feelings such as sadness, guilt, shame, anger, or frustration. As a result of what comes out of your therapeutic work and the decisions you make, important relationships may be impacted or may end. Your journey in therapy may also lead to healthier relationships. Therapy support often helps an individual find solutions to problems with family and friends, life challenges, as well as a reduction in feelings of distress, anxiety and depression. If you ever have any concerns about your therapy process, we encourage you to discuss this with your therapist during your sessions or with one of Trailhead’s owners, Jimmy Hill, LPC-MHSP and Logan Mahan, LCSW, so that we can collaborate together as you move forward.

For all emergencies, call 911.

​

Termination of Therapy:

Therapy is a process that is unique to each client and the challenges they are presenting with. Some presenting issues can be worked on very effectively in a fairly short period of time (10-20 sessions). Other challenges may take much longer. You and your therapist will put together a treatment plan and goals that you will be working toward after your first visit. If you have questions regarding the length of treatment, please feel free to discuss this with your therapist at the start and/or at any point during therapy.

​

Dual Therapy:

It is unethical for two different therapists to provide therapy for the same client at the same time. Unless there is a compelling clinical reason such as a crisis, or a specialized therapy treatment plan that we will be working on, the therapists with Trailhead Treatment Center do not work with clients who are under the care of another therapist. If you are working with another therapist, please disclose this so that we can discuss next steps. If your therapist has referred you to Trailhead Treatment Center for specialized treatment (i.e. sex addiction recovery or trauma recovery, for example), we will need to have a release on file from you in order to coordinate care with your primary therapist and collaborate on a clinical plan that best supports your process.

​

Confidentiality:

Therapy is best experienced in an atmosphere of trust. Thus, all therapy services are strictly confidential and may not be revealed to anyone without your written permission. There are exceptions to confidentiality where disclosure is required by law (explained further ahead). There may be occasions where your therapist may consult with adjunct therapists in order to discuss aspects of your sessions to best support your process. When doing so, please understand that your name will not be used and your therapist will change significant identifying details in order to protect your confidentiality. Your confidentiality is very important to us. Should you request that your therapist speak with another professional or person (i.e. doctors, former therapists, teachers, family, friends or anyone else outside the therapy room), you must first provide your signed written consent in order to do so and only after your therapist determines if this is in the best interest of supporting your therapeutic process and progress.

​

Confidential Electronic Data Storage and Email Transmission:

Your confidentiality as a client is of utmost importance. To support and secure your clinical information, Trailhead Treatment Center has set up a system as part of our therapeutic services in order to securely store and protect your information in a confidential and protected capacity. Trailhead Treatment Center and its affiliate therapists will be utilizing therapy notes and Simple Practice and Google Inc. and the following applications: Gmail to confidentially communicate with clients in various capacities via the Internet. Gmail and all client protected health information are covered under the Health Insurance and Portability Act of 1996 and in particular 45 C.F.R, Part 164, Subpart C under HIPAA.

​

Legal Exceptions to Confidentiality:

The therapists, affiliate therapists and staff at Trailhead Treatment Center take confidentiality very seriously. Your information is confidential, with the exception of information relating to child abuse, or suspected child abuse, child pornography, elder abuse, dependent adult abuse, or intent to harm self or others, or unless mandated by a court of law. Legally, therapists are mandated reporters of abuse or intent to harm another. If you are suicidal or homicidal, your therapist with Trailhead Treatment Center will take all reasonable steps to prevent harm to you or another. Legal exceptions to confidentiality are in place to protect your safety and the safety of others. This includes: when there is a reasonable suspicion of child abuse (physical, sexual, emotional, neglect), or adult dependent care abuse, elder abuse/neglect; and where a client threatens to harm or kill other(s) (homicide), or threatens to damage another person’s property. If you are homicidal and make a serious threat to hurt another person(s), your therapist will contact 911 and make every attempt to warn the intended victim or victims. Additionally, if a court issues an order to release records (for example a divorce hearing or custody hearing), your therapist must abide by the court order and may be compelled by court order to testify under oath and thus must answer all questions honestly.
 

Mandated Reporting of Incidents Involving Minors:

A minor is defined as any person who is legally under the age of 18. Under United States law, if your therapist has reason to believe that a child has been subjected to abuse or neglect, or observes a child being subjected to conditions or circumstances which would reasonably result in abuse or neglect, your therapist shall immediately notify the nearest peace officer, law enforcement agency, or office of the division.

​

Practice Policies

​

No Secrets Policy:

Please note that with couples and family therapy the couple and/or the family is the client (e.g. the treatment unit), not the individuals. As such all therapists and affiliate therapists with Trailhead Treatment Center practice a no-secrets policy when conducting marital/couples/family therapy. This means that confidentiality does not apply between the couple or among family members when one member of the treatment unit requests an individual session or contacts their Trailhead Treatment Center therapist outside of the therapy session to share a secret. On occasion, an individual session may be scheduled to assist in the overall therapy process to the treatment unit (e.g. the couple) and will be scheduled only when mutually agreed upon. Please understand that any information given in the individual sessions will not be held in confidence or secret in couples and/or family sessions. Your therapist will encourage the person holding the secret to share the secret in the following session and will support the client in doing so.

Your therapist also reserves the right to share or disclose information revealed by one partner or family member in an individual session to the other partner or family members as deemed appropriate or necessary to support the treatment units overall treatment progress and goals. If you are seeking couples therapy, or family therapy, please have each member of the treatment unit fill out and sign an intake form.

​

Conjoint Sessions:

On occasion, and only if it benefits the client’s therapy goals, your therapist may ask that a family member or significant other join you for a therapy session. It is important to note that this is done only on occasion and at the therapist’s discretion when it best serves the client. If a family member or significant other agrees to meet for a session, it will be for the client’s benefit. If the person joining the session is your significant other, this does not constitute as couples therapy, rather it is as a support to your work, and/or a check-in session. Additionally, the third party (friend or significant other) is not joining the session for his or her own therapy, nor will your therapist with Trailhead Treatment Center work with them as a therapist. If we decide that this would be beneficial, you will need to sign a written release of information for this type of conjoint session.

​

Therapy Sessions:

Therapy sessions are generally scheduled on a weekly basis, and are scheduled in advance. Standard sessions are 50-minutes in length and begin and end on time. Therapy can be conducted in office or over the video conference if you are away on business, ill, or cannot make it into the office for any other reason. The fee is the same for in-office or teletherapy as the same amount of time must be blocked out for teletherapy sessions. It is understandable that occasionally you may be late. If you are late to your session, please understand that the session will not extend past your 50-minutes, nor will the time be made up at future sessions, as this will impact other clients.

Longer sessions are available by request and upon availability of your therapist’s schedule at a prorated fee. At the start of therapy, your therapist may extend your first few sessions past the 50 minutes. However, unless your therapist chooses to extend this time, we ask that you please respect your 50-minute session time. If your therapist finds that your session tends to run longer, he or she will discuss this in session in order to maintain healthy boundaries around starting and ending on time.

​

Non-Discrimination Policy:

We respect each person’s right to choose his or her own belief system. The therapists with Trailhead Treatment Center work with clients of all beliefs. Additionally, the therapists with Trailhead Treatment Center respect each person’s right to their choices in terms of sexual orientation, and provide a safe place for straight, gay and transgender clients. The therapists with Trailhead Treatment Center believe in supporting people of all ethnicities, cultures and physical challenges. While our gender, ethnicity, orientation or spirituality may be different, we are open to discussing any concerns or questions you may have in working with a therapist who is either a different race, religion, orientation or gender than you. Having an open discussion on any of these topics can lead to a greater level of trust and rapport. If you have any questions regarding our therapeutic approach and style, or our non-discrimination policies, please feel free to discuss this with your therapist now and/or in the future.

​

Suicide Policy:

If you are suicidal, your therapist will take all reasonable steps to prevent harm to yourself. This may include breaking confidentiality if you pose a serious risk of self-harm. Your signature indicates that you have read and understand confidentiality and limits to confidentiality.

​

Court Reports or Letters:

The therapists/affiliate therapists with Trailhead Treatment Center do not write legal letters or court reports on behalf of clients involving divorce, custody or other legal matters or lawsuits. We do not write letters pertaining to legal matters to any outside person (i.e. doctor, school, attorney, etc.) or agency regarding your treatment. If a special circumstance arises where a letter is required by court order, it will require your written consent and will be billed to you at $25.00 per page and in addition to our hourly fee. We reserve the right to refuse to write letters on your behalf (unless court mandated) if we do not feel this would be in your best interest, if it places us in a dual relationship, or will compromise our therapeutic relationship. We will not write letters on your behalf if you are involved in a lawsuit for any aspect of your personal or professional life, as this places us in a dual relationship as both your therapist and court advocate, thus crossing therapeutic boundaries. If you are involved in a lawsuit, please understand that entering your mental health into a court hearing may not always be in your best interest as it may compromise your confidentiality and your clinical files may be requested and your therapist must speak honestly if under oath. Your therapist will not be your advocate in a court hearing or speak on your behalf as that is not the nature of the therapist/client relationship.

​

Court Fees:

If you become involved in legal proceedings that require your therapist’s mandated participation, you will be expected to pay for all of your therapist’s professional time, including preparation and transportation time and costs, even if called to testify by another party. Because of the time involved and the interruption to my clinical work, you will be charged $250 per hour for time out of practice, time for preparation, travel time, and attendance at any legal proceeding on your behalf that you will be responsible for. A retainer of $1000 is due two weeks prior to the court hearing and will only be refunded if the court hearing is cancelled one week prior to the scheduled date.

Additionally, if other client sessions must be cancelled, these must be covered at the rate of those sessions and will be billed to you. Court fees can be very expensive so please sign and date below to indicate that you understand your financial responsibility in covering these expenses should your therapist be mandated to go to court for a legal issue you are involved in. A therapist is not a court advocate or friend. A therapist must legally speak truthfully under oath.

​

Healthcare/Managed Care Insurance Policy:

In order for the therapist to be reimbursed by an insurance company, a diagnosis of the client must be made and submitted to the insurance carrier before the therapist is paid. Sometimes information on the presenting problem and symptoms the client is experiencing from the client’s private therapy records are also required by the insurance company.

This information once released becomes part of the client’s medical records and may impact confidentiality. Because of this, Trailhead Treatment Center therapists may choose to work with Managed Care Health Insurance programs at their own individual and private discretion. This means that some Trailhead Treatment Center therapists may be on some insurance panels, and others are not; should a client switch from one therapist to another, their insurance benefits may differ.

We are glad to provide a superbill receipt on a monthly basis that you may submit to your insurance company if you wish for a possible out-of-network reimbursement. However, Trailhead Treatment Center will not fill out forms or work directly with or on your behalf with your health care insurance company for insurance reimbursements.

​

Additionally, it is important that you also understand that there is no guarantee that your insurance carrier will cover your therapy sessions. We ask that clients carefully consider this before we begin our work together. If you choose to work with Trailhead Treatment Center therapists, our policy is a fee-for-service policy as described in the following section. You understand and agree to respect this policy around managed care health insurance, and will honor this agreement now and in the future.

​

Payment:

Therapy sessions are paid via credit or debit card. Please fill out the credit card form included in this packet. This information is stored securely and is password protected. We charge clients on the day of their session. Some clients prefer to pay by cash for confidential reasons. Please bring the exact cash amount for your session fee.

​

We can make arrangements to bill a third party after we have confirmed the agreement with the billing party you’ve listed. If payment from the third party is not received, you will be responsible for your balance and any fees that are applied.

​

We do not “carry over” session payments from week to week, or extend credit as this could constitute as an unethical “debtor/creditor” dual relationship and ultimately impact the therapeutic relationship.

If your account becomes past due, we will take the necessary steps to collect this debt. If we have to refer your accounts to a collection agency, you agree to pay all of the collection costs that are incurred. If we refer collection of the balance to a lawyer, you agree to pay all lawyers’ fees that we incur plus all Court costs.

​

At times, a single session’s rate may need adjustment due to such reasons as the session becoming a couples session versus an individual therapy session, or if the therapist deems more work is necessary to prepare. These rate adjustments will be applied to your balance and billed accordingly.

Release for Third-Party Payers:

​

As a new Trailhead Treatment Center, PLLC policy, effective 11/10/2020, if your therapy services are being paid for by a third party such as a parent or religious organization, you are required to sign a limited release of your presence in treatment for that third party. This release allows us to send the third-party invoices reflecting the amount charged, the service rendered, and any charges for late cancels, late-reschedules, or no-shows. The third-party payer will also be sent a copy of your signed agreement to our payment policy.

​

Blueprint Assessment Portal Fee:
Trailhead clinicians and their clients have access to a comprehensive, evidence-based, and HIPAA-compliant Measurement-Based Care interface called Blueprint. Blueprint is a user-friendly interface that equips clients and their therapists with the best tools to understand clients’ mental health challenges and track their progress during their time in therapy.

​

Research suggests that Measurement-Based Care not only improves therapeutic outcomes but also decreases clients' overall expense in treatment. Clients tend to have increased engagement and accelerated healing when using Measurement-Based Care. To cover the cost of our Blueprint, a flat, nominal fee of five dollars per month will be charged to all clients who have at least one therapy session in that month. This fee does not increase based on how many additional sessions a client has in a given month, nor does it increase based on how many assessments clients complete in the Blueprint portal. Due to the Blueprint subscription requirements and limitations on our own billing processes, it is not feasible for individual clients to opt out of the five-dollar monthly fee, even if they do not desire to utilize Blueprint as part of their therapeutic experience at Trailhead. By scheduling an appointment in a given month, you, the client, are agreeing to pay the five-dollar assessment fee for that month, independent of whether you utilize Blueprint. This service and fee exist independent of health insurance coverage, and thus all clients will be required to pay the five-dollar fee, independent of whether or not they utilize insurance to cover the cost of their therapy sessions.

​

Fee Increases

Fees are reviewed each year, and may increase periodically. Every consideration to a client’s current finances will be made. The increase will be discussed with the client, and a 30-day notice will be given prior to the increase. We will be happy to answer any questions you may have about this fee agreement. Please understand that you have the right to terminate therapy at any point. If you have any questions regarding the fee policy, please do not sign until discussing with our Office Manager.

​

Appointments/Cancellations

If you are trying to reach your therapist on the same day of your session, please contact your therapist via the phone number you have been given vs. an email. Please note that cell phones cannot be guaranteed as confidential. We make every effort to return calls and emails within 24 business hours. We understand that occasionally circumstances beyond your control may arise which would prevent you from keeping your appointment. If your therapist is unable to attend your therapy session (outside of scheduled vacations) due to an unexpected emergency or illness, every attempt will be made to contact you 24 business hours in advance on the phone numbers and/or email you have provided. If you are sick or experiencing any symptoms of illness, we ask that you conduct your session via the phone or cancel the appointment. If your therapist is ill, he or she will extend the same consideration.

​

Cancellations/Reschedules

If you need to cancel or reschedule an appointment, please do so one full business day (24 hours) before your scheduled appointment (Monday appointments need to be canceled the Friday before) and during our customer support hours. If you fail to cancel or reschedule within one business day during customer support hours, this will be considered a Late Cancel and you will be charged the full amount the morning of your scheduled session.

​

Pro bono appointments that are cancelled within 24 business hours of the appointment will be charged the therapist’s rate for that appointment.

​

Intensives: There is a 30 day cancellation policy for all intensives. If you cancel within 30 days of the start date, you will receive 50% of your deposit back. If you cancel within two weeks of the start date, you forfeit your deposit.

​

No-Show

If you do not show up for a scheduled appointment (that you have not called to cancel), you will be charged the full fee for the session. If you tend to forget appointments you can log in to your secure Client Portal to see all upcoming sessions. We also have the ability to send out a reminder of the date of your upcoming appointment. However, you are responsible for keeping track and attending your sessions.

If you are utilizing insurance or third-party pay and you No-Show or Late Cancel an appointment, you will be charged directly for the appointment fee to the card on file.

​

Bad Weather

For instances of weather preventing you from attending your appointment in person, we ask that you meet with your therapist virtually via video conference. Missed appointments that have not been canceled or rescheduled within 24 business hours will be charged the full amount on the day of the session.

​

Ongoing Cancellations or Multiple No-Shows

It is understandable that occasionally an appointment will be canceled or missed due to illness or emergency. However, your regular session day/time has been reserved for you. Our current client schedule and waitlists do not allow for a great deal of flexibility with respect to continual cancellations, rescheduled appointments, or no-shows. If you find that your schedule is no longer able to accommodate the session time reserved for you, please discuss this with your therapist. They will do their very best to find an alternative solution, such as virtual sessions, so that we can continue our work together. However, please note that should ongoing cancellations, frequent reschedules (even those within the same week), missed appointments, or late payments/nonpayment become an issue, your therapist will discuss this with you. If after discussing other options with you, your attendance has not changed, we will need to open up your reserved time to the waitlist and add you to the waitlist. If you prefer not to be placed on the waitlist, then we will provide you with three therapy referrals and/or terminate with you.

​

Explanation of Dual Relationship

While a therapeutic relationship can feel psychologically close, it is one that is professional in nature with important boundaries. It is unethical for a therapist to invite you into a business venture, ask you for personal favors, start a social relationship with you, etc. These examples are called, “dual relationships” and can negatively impact clinical boundaries. Although our sessions may be intimate psychologically, it is important to acknowledge that we have a strictly professional relationship. On the rare occasion that your therapist sees a client outside of the office (when we may accidentally run into each other in public), your therapist will be highly discreet and will maintain your confidentiality. The therapist will do their best to follow your lead, and thus it is your choice to acknowledge the encounter and your therapist. If you do not choose to acknowledge the encounter, your therapist will respect this and will follow your lead.

​

Illness Policy

When a private practice therapist is consistently exposed to cold and flu viruses in the office and becomes ill as a result, the office closes down, sessions and groups are cancelled, and everyone suffers. In order to maintain good health and create a safe and relatively germ free environment so that Trailhead Treatment Center can support all of our clients, we ask that clients who are experiencing any stage of illnesses to respect safety boundaries and to conduct their sessions via virtually until they are recovered completely and are not experiencing any signs of illness, fever, rash or cough or contagious symptoms at any stage.

Stage of illness includes: starting to feel flu symptoms, suspect they may be coming down with the flu, dealing with a current cold, head cold, or flu or flu-like symptoms, or are at the end of a flu cycle, currently have the flu, a cough, a cold, pink eye, contagious rashes, scabies, lice, chicken pox (or a child with chickenpox), or any other potentially contagious illnesses no matter how mild. Your therapist will extend the same respect and consideration if we are ill.

​

If you are ill with a head cold, flu, lice, virus, chicken pox, pink eye, scabies, or any other potentially contagious illness at any stage no matter how mild that would potentially expose your therapist or others in the therapy office, you agree to alert your Trailhead Treatment Center therapist or representative, and either reschedule your session, or agree to conduct your individual therapy session via phone or video conference if you are ill, feel as if you are becoming ill, or are at the end of a flu virus.

​

Your therapist may, on rare occasion, ask that your session be conducted via phone or video if she is ill or recovering from a contagious flu virus.

​

If you are seeing a Trailhead Treatment Center therapist for couple’s therapy, you agree to cancel the session in advance if your spouse or you are ill.

​

Client Consent: Clients that sign this document agree to the following:

​

• I have thoroughly read and fully understand the Informed Consent pages of this document.

• I have thoroughly read and fully understand the Practice Policies pages of this document.

• I understand that I am financially responsible for charges and fees incurred. And I agree to honor the non-cancellation policy.

• I understand limits of confidentiality and all mandated reporting by my therapist.

• I understand that emailing, texting and cell phone are not guaranteed as confidential.

• I understand and agree to the illness policy and will conduct sessions via phone or video if I am ill and agree that if my therapist is ill, she/he will conduct via phone.

• I authorize my therapist/affiliate therapists with Trailhead Treatment Center to provide psychotherapeutic treatment for me.

​