Confidentiality Information and Consent

Please read prior to first session

 

Vivian L. Morgan, MS, LCPC

Licensed Counselor for Children, Adolescents, and Families

Information and Consent for Treatment

I hold a Master’s of Science in Clinical Psychology from Alabama A&M University (1988) and have taken additional coursework at Loyola University of Maryland, and Johns Hopkins University. I continue to take on-going trainings and workshops in expressive, mind-body, and cognitive therapies in order to provide a range of services to my clients.

When working with families and children I use a solution-focused and family systems orientation believing that the family is a great source of resources and understanding when solving problems. I have training in CBT (Cognitive Behavioral Therapy) and many years of experience working with children in schools with behavioral or inattentive/ADHD concerns. I take a creative and expressive approach (using art and sand tray therapies, along with meditation and yoga exercises) when working with children, teens, and families knowing that help and relief can come from a variety of places.

I offer individual, family, parent-child, and group therapy experiences. From time to time I will offer retreats or group sessions to children and parents in order to enhance self-knowledge and personal growth. I may also suggest other classes, books, or workshops that may be helpful.

Confidentiality: Your information is considered privileged and private and will not be shared with others. If I bring your case up during peer supervision I will not reveal your name or identifying information. Email or text information will only relate to scheduling times or information regarding insurance submission.

Should one of the following circumstances occur, I am obliged by law to break confidentiality and request assistance:

· If you should threaten to harm yourself or someone else.

· If you are involved in legal action and the court has ordered your records.

· If you or your child states that they are being abused or neglected (verbally, physically, or sexually), or the suspicion of abuse arises.

· If the abuse of a vulnerable adult is revealed.

Children under the age of 16: Parents can request services for their children and information regarding their treatment is available to parents. Both parents, even if a child is from a divorced home, as long as they both have custodial rights, are requested to be informed of counseling. It is critical that parents both support the efforts of doing what is best for their child’s well-being. I will not participate in custody evaluations and do not have the training required to do so. I encourage parents to be respectful of the counseling and therapy experience for teens, who often are looking for a place to confide personal experiences and sort through conflicts and struggles. I will offer parents general information about progress and allow the teens to determine what they are comfortable sharing unless their is cause for concern. Safety is critical and I will let them know parents will be informed of risky or unsafe behavior.

Children over the age of 16: Adolescents can request psychological and counseling services without the consent of an adult, although most teens arrive for therapy upon the request and support of their parents. I will keep their records confidential and they can make determinations as to who has privilege to this information. I encourage adolescents and parents to discuss treatment in a way that is supportive, not intrusive, and based on the teen’s discretion. If a teen should share that they are using drugs or substances or engaging in harmful behavior we will engage in a discussion as to how to share this with their parent. It is important to me that your child is safe. A teen cannot refuse treatment if concerned adults think it is in their best interest.

Client-Therapist Relationship: The therapeutic relationship should feel safe and open. I encourage you to share your life stories and be open to looking at your world in a new way, and to incorporate new strategies in working through life’s obstacles. I will ask you about your progress from time to time and will offer feedback on the process – I encourage you to do the same. It is important that we have an honest and helpful relationship.

Termination of Services: I have the right to terminate services at any time at my discretion. You also have this right. Reasons for termination may include, failure to pay for services in a timely manner, failure to comply with treatment strategies, conflicts of interest, or if your needs are outside the scope of my competency. Typically, we will discuss these issues in therapy, and termination will occur as a result of you feeling more comfort in addressing your referring issues and feeling a sense of relief or accomplishment.

Cancellation of Appointments: My policy is that you are to notify me if you decide to cancel your appointment 24 hours before your scheduled appointment time. If you are not able to do so, you will be charged a $50 fee for service. I understand if sudden issues or illnesses come up, however, a pattern of not showing for appointments will result in billing for services.

Contact Information: I am available via phone contact outside of the therapy session, however, these contacts need to be less than 15 minutes. If you need more time, we can schedule an appointment at that time. If you should see me in a public setting or in a social media setting, please don’t be offended if I do not greet or pursue contact with you outside our therapeutic setting. I am being respectful of your privacy, and considering what is best to preserve the integrity of my practice and your progress.

Cost of Sessions: If you are in an insurance program that I am a part of I am dictated by that plan as to fees and what your co-pay is per visit, and expect you to pay that at the time of the visit. If you are out of network, you may be able to meet a deductible and have your insurance company reimburse you for services. At your session I will offer you a statement/bill that reflects what you have paid for counseling and you can submit this to your insurance company for payment against your deductible and for reimbursement. Fees for service run $200 for the Initial Evaluation and $150 for individual or family sessions. If you wish for me to consult with your child’s school these consultations are $150 per hour. Phone consultations/counseling for more than 10 minutes will be charged a portion of the hourly rate.

Emergency Situations: If you should experience an emergency where your emotional or physical health and safety are in question you should call 911 or go to your nearest hospital. I am not available after hours.


You will have the opportunity to review and sign at your first session:

My signature below signifies that I have read, understand, and am in agreement with the above-stated policies.

Client (Print Name): ____________________________________

Client’s Signature: _____________________________Date: __________

Parent’s Signature: _____________________________Date: __________

Parent’s Signature: _____________________________Date: __________