Peer Services Agreement
Please review this document and acknowledge your willingness to engage in the receipt of recovery support services from a peer support specialist at RecoveryLink (the provider organization).
Here is what you can expect from your peer specialist:
Your peer will support you and help you to establish a plan for life in recovery.
Your peer will help you to connect with people, services, institutions, and communities that can help you succeed in and enjoy your recovery.
The centerpiece of the relationship is a constantly developing Recovery Plan. Conversations will focus on goal setting, problem-solving, and celebrating all positive changes. As your recovery is unique to you and belongs to you, your recovery planning will be unique and driven by you.
Your peer will keep their relationship with you confidential, but will acknowledge your participation in this program if you request that I do so in writing.
Depending on your individual circumstances and wishes, your peer may provide general information about your recovery progress and / or challenges to your service payors, service providers, and / or caretakers.
Your peer is legally and ethically obligated to report any disclosure of personal involvement with child or elder abuse/neglect, threatened self-harm, or harm to others.
Your peer does not provide clinical assessments, recommend any particular level or type of care, provide clinical treatment services, maintain clinical records, or dispense medications.
Here is what is expected from you:
Your recovery is your responsibility. Any decisions you make after considering your options in the recovery services engagement process are your decisions and your responsibility.
You understand and agree that you will not seek to hold your peer or the peer provider organization and any of the peer provider organizations’ agents legally responsible for your decisions or actions.
Keep appointments made and be on time to each appointment. If you are unable to keep your scheduled appointment, please contact your peer as soon as possible.
You can contact the peer provider organization supervisor with any questions or concerns you have about your experience with the program or if you feel you might benefit from having a different peer specialist.
Together, you and your peer specialist will explore what you can do to meet your recovery-oriented goals. We will support you in taking action and making your recovery successful.
Your signature below means that you have read the above policy and that you fully understand the expectations as a participant.
Declaration of Confidentiality
As an individual engaging with peer recovery support services, you have the right to confidentiality. This means that peer provider organization staff do not have the right to share any information about you verbally or in writing with anyone outside the organization and your support team without your written consent. However, in some cases, the organization must bring outside individuals into the relationship, without your consent, to ensure your safety and well-being and that of others.
Everything you say, do, express is confidential EXCEPT:
Intent or plan(s) to harm yourself
Intent or plan(s) to harm another person
Knowledge or case(s) of a child or elderly person being abused/harmed/neglected
In an emergency situation regarding your physical safety
If a warrant signed by a judge and served by law enforcement demands release.
Also, please note that information about you may be shared with co-workers and supervisors at the organization only to obtain professional guidance and suggestions regarding care planning and referrals. Discretion will be used in these cases.
The organization collects personal information and take considerable measures to protect any information collected, stored, transported, and shared. We may be required by your payor entity to collect personal information and report on your progress. Other personal information that we collect is to provide you with appropriate and quality services.
Your signature below means that you have read the above confidentiality policy and that you fully understand your rights as a participant.
PARTICIPANT TELERECOVERY SUPPORT SERVICES CONSENT
PURPOSE: The purpose of "PARTICIPANT TELERECOVERY SUPPORT SERVICES CONSENT" is to get the participant's consent in order to participate and receive recovery support services via telephonic/digital means.
RECORDS: Communications with participants will not be recorded and stored. Participants recovery and health information obtained in engagements as part of the service delivery relationship can be used anonymously for further improvements in the organization's services and/or scientific studies.
TELEMEDICINE INFORMATION: The recovery and health information related to history, records, and engagements of the participant may be discussed during the telerecovery appointment with video, text, and/or audio.
ACCESS: The participant accepts that they need access to PC, laptop, or mobile device and a good internet connection in order to have an efficient telerecovery appointment.
PARTICIPANT RIGHTS: The participant can withdraw their consent at any time and can ask the questions related to telerecovery appointments and technical requirements for telecommunication.
Your signature below means that you have read the above telerecovery policy and that you fully understand your rights as a participant.