Informed Consent for Psychoeducation via Video Conference Call

 Welcome, and thank you for your interest in our services. The following includes information about your rights as a participant, and it is important that you read the following in its entirety.

 

Fee for Service

​

There is a cost associated with both group and individual services. Payment is due before the start of any session.

 

If participating in a group, full payment for the entire series is due before attending any sessions. It is your responsibility to make an informed decision about your ability to attend this group before submitting payment. Space is limited, and your spot in the group is reserved for you upon receipt of payment. Early withdrawals or missed sessions are non-refundable.

 

Psychoeducation vs. Psychotherapy (Anger Management groups)

 

Psychoeducational groups are educational in design and purpose and are not therapeutic or a replacement for psychotherapy. In these psychoeducational group sessions, the facilitator will present to attendees evidence-based material that has been found to be useful for people wishing to address concerns related to the group topic. Time is allowed for discussion, and opportunities for you to share how concepts relate to your personal life are built into the curriculum. If issues arise that are not suitable for this educational experience, you may benefit from individual psychotherapy.

 

Risks of Psychoeducation (Anger Management groups)

 

Psychoeducation has been shown to have many benefits, including improved insight, increased understanding, and affirming support. However, since psychoeducation may involve discussing many parts of your life, including, at times, the unpleasant aspects, you may also

experience uncomfortable feelings. You should be aware that psychoeducation may or may not lead to direct improvements in your life. You should also be aware that if psychoeducation induces change in your life, these changes may disrupt your accustomed manner of living and

your relationships with others.

 

Virtual/Online Meetings

​

Video conference calling allows for improved accessibility. However, there are some factors that are important for you to understand. We make an effort to protect sensitive information, but there are inherent risks to conducting business using the internet, computers, and other technology, including unauthorized access. Disruptions of signals and problems with the internet’s infrastructure may cause broadcast and reception problems.

​

To maintain confidentiality, sharing your meeting link with anyone unauthorized to attend your session and any type of recording (video, audio, etc.) of sessions is strictly forbidden.

​

Unforeseen Circumstances

​

Your provider will make every effort to be present and prepared for each session as it was originally scheduled. However, unforeseen circumstances such as internet disruption, issues with necessary technology/computer equipment, and illness may lead to the cancellation. Depending on the nature of the disruption, advance notice may or may not be possible. Someone will reach out to you when communication capabilities are restored.

 

Records

 

We keep electronic records for all clients. Records include identifying information and contact details, such as phone numbers and email addresses. We also make note of client engagement in sessions and keep records of what clients share during sessions. A professional assessment may also be included.

 

Security breaches may result in unauthorized access to identifying or sensitive information. In the unlikely event of a security breach, you will be notified of the nature of the breach and what information may have been accessible to an unauthorized party.

 

You may request a copy of your records and are responsible for any costs incurred. If you would like records to be sent to someone other than yourself, you must provide a Release of Information detailing your consent.

 

Confidentiality

 

You have the right to confidentiality under federal and state laws relating to the receipt of services.

 

There are some Limits to Confidentiality. All of our providers are mandated reporters and have a Duty to Warn and Protect:

​

• If you disclose a plan or threat to harm yourself, your facilitator must notify legal authorities. In addition, if you disclose a plan to harm another person, your facilitator is required to attempt to warn the possible victim and notify legal authorities.

  1. Abuse of Children and Vulnerable Adults

• If you disclose, or it is suspected, that there is abuse or harmful neglect of children or vulnerable adults (i.e. the elderly, disabled), your facilitator must report this information to the appropriate state agency and/or legal authorities.

​

Attendance Policy

​

It is important to be on time and prepared for all scheduled appointments with EmpowerAbility. You will be charged the full fee for any appointments that are not canceled at least 48 hours in advance.

​

No-Shows and Late Cancelations:

​

EmpowerAbility is offering a service to me that is in high demand. Your provider’s time is valuable, and when you schedule an appointment, that time is dedicated to you.

​

Your provider will wait up to 10 minutes for you to arrive for a scheduled appointment. Your provider will no longer be available to meet with you if I am more than 10 minutes late. If you know that you are going to be late for a scheduled appointment, please contact your provider and request a late start time. Your provider is not obligated to approve that request. 

​

If you do not show up for a scheduled appointment without first contacting EmpowerAbility:
1.       You will be removed from my recurring appointment time, if applicable
2.       You will be responsible for contacting EmpowerAbility to reschedule your appointment

 

You will be discharged from services if you:
•    No call/no show for a scheduled appointment 3 times; OR
•    Reschedule or cancel three appointments with less than a 24-hour notice 3 times; OR
•    No call/no show and/or cancel with short notice a total of 3 appointments in any combination
 
If you are discharged from services for any reason, including attendance, you may need to be added to a waitlist if you want to re-establish services. This waitlist may be several months long.

​

TWOFOLD HEALTH

 

General Notice

​

EmpowerAbility has chosen to use Twofold Health's transcription tool, which provides an automatically generated summarization of sessions. Twofold Health's system is HIPAA-compliant and uses up-to-date encryption methods and multiple layers of security and privacy technology to keep your information private and secure. Twofold will never have access to any identifying information, such as last name, date of birth, Social Security number, or contact information.

 

Details

 

1. Data Collection and Use
•    Transcription and Summarization: Recordings of your sessions will be transcribed and summarized by Twofold Health’s HIPAA-compliant 
•     technology. Twofold Health does not store the recordings.
•    Anonymized Data: Twofold Health only keeps anonymized data to help improve the tool. As with any technology, there are certain risks and benefits, which are listed below:
 
2. Risks and Mitigations
•    Confidentiality: All technology carries a risk of information being disclosed. Twofold Health mitigates this risk by ensuring up-to-date technological security and storing the data with minimal identifying information. Your provider will also refrain from entering Protected Health/Identifying Information (PHI), aside from first name, into TwoFold’s system.
•    Bias in Summarization: The system may contain unknown biases in the way it generates the session summary and presents clinical information. This risk is mitigated by your provider’s commitment to review and modify the notes as needed using their clinical expertise.
•    Twofold Health researchers will have access to your de-personalized transcripts (with names and other identifying information removed) solely for the purpose of improving the product and for specific customer support inquiries when requested.

 

3. Benefits
•    Focus on Care: The technology allows your provider to focus more on care.
•    Reduction in Administrative Workload: It removes the need for taking notes during the session, reducing the administrative workload and potentially helping with compassion fatigue.
•    Improved Clinical Insights: The technology may provide additional clinical insights, helping to improve outcomes in the care process.