CONSENT FOR TREATMENT AND COUNSELING
Welcome to Devoted Transformations LLC. My name is Toni Watson, and I am a Licensed Clinical Social Worker (LCSW). I currently supervise other associate licensed counselors and their information will be listed below. We are very excited to begin working with you! We hope to start a journey with you for healing and transformation. This consent provides you with important information that you will need to begin services. Please let me know if you have any questions or concerns.
PURPOSE OF TREATMENT
Counseling is a journey to healing that can help to create positive changes in thinking, feeling, and behaviors. Counseling is not meant to solve the struggles that you might be enduring. Instead, counseling is designed to be able to teach you tools that will aid in you making the positive changes yourself. These skills will need to be practiced consistently to make lifelong changes. There are various skills and techniques that can be utilized to assist in these changes. My goal of counseling is to be able to provide you with these tools and techniques.
RISKS AND BENEFITS
Counseling comes with risks and benefits. Some risks of counseling could possibly be an increase in experiencing troublesome emotions such as pain, guilt, shame, or sadness. This is a normal process of recalling previous events from your history that can sometimes be uncomfortable or confusing. Some other risks could be that the changes impact your personal relationships or daily living environment. However, the benefits of counseling are often shown to outweigh these risks. Benefits include an overall decrease in negative emotions, increase in more positive thinking habits, ability to resolve problems independently, and an overall higher satisfaction with quality of life.
COURSE OF TREATMENT
Our journey together will begin with an initial assessment. During this session, we will begin by discussing your most prominent concern that brought you into counseling and any other relevant information related to this issue. I will complete a thorough biopsychosocial assessment where I will gather background from many different areas of your life. This will help me to gain better insight into where the main concern may have started to develop. Following the assessment session, we will come together to develop a mutually agreed upon treatment plan that covers the identified problems with specific goals. Within those goals will be objectives that have interventions identified with your specific needs in mind. Treatment plans will be individualized to utilize your strengths and support while identifying skills that will need to be learned. Treatment plans will be reassessed throughout treatment to identify progress as well as if any adjustments are needed. Discharge will be discussed from the very beginning so we have our end goal together in mind and can work to complete this journey of transformation. At any point in time during services being provided, you may cancel services. Services being terminated early will be encouraged to follow up with referrals and complete discharge planning prior to services officially ending.
ABOUT ME
I am a Licensed Clinical Social Worker in Arizona. I am licensed at the clinical level and can practice independently. My licenseis held with the Arizona Board of Behavioral Health Examiners (AZBBHE). If you have concerns about the treatment that I am providing, you may contact me directly at 623-696-5948. If you are still dissatisfied or have concerns about my treatment methods, you may make complaints or report concerns to AZBBHE, 1740 West Adams St. #3600 Phoenix, AZ 85007, 602-542-1882.
I have been working as a social worker for many years in diverse fields that have covered a variety of different populations. I have worked with children, adults, families, and couples. I have worked in multiple settings that have included hospitals/inpatient, residential, partial hospitalization programs (PHP), intensive outpatient programs (IOP), and outpatient. I have worked with individuals struggling with depression, anxiety, bipolar, psychosis, eating disorders, addictions, and various other diagnoses. I am trained in numerous modalities that include eye movement desensitization and reprocessing (EMDR), sand tray therapy, cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), solution focused therapy (SFT), narrative therapy, motivational interviewing, and other evidenced based treatments.
BILLING AND COPAYS
Devoted Transformations LLC accepts clients who will be utilizing insurance as well as clients who will self-pay. If utilizing insurance, Devoted Transformations LLC will bill your insurance directly. Copays will be collected at the time of the visit through a secure portal. Self-pay rates will be discussed and provided to you prior to services being rendered. Refunds will not be given after rendering of services.
EMERGENCIES AND AFTER HOURS
If you are having a life-threatening emergency, please call 911. Otherwise, you may contact the crisis line 24 hours a day through EMPACT-SPC crisis line at 480-784-1500. After hours, you may contact me, Toni Watson, directly at 623-696-5948.
CLIENT RECORDS
All client records are stored in a HIPAA compliant medical record keeping system. Records will be kept for seven years after discharge. You have a right to your records at any time. If you are requesting for your records, please submit the request to Devoted Transformations LLC by complete the medical request form and allow 7 business days for the records to be provided.
RECORD SHARING
Your records will always be kept private unless you designate for records to be shared. A release of information will be required to release any records for anyone other than yourself. Please allow for 7 business days to have records sent once the ROI has been completed. There may be times when court orders will request for sharing of records that will be required. If you are utilizing insurance, you are also authorizing for your records to be shared with them regarding your treatment and services being provided. At times they may request information that includes, but is not limited to, the diagnosis, assessment, treatment plan, progress notes, and prognosis. This is their right to verify services being billed.
GUARDIANS OVER MINORS
Currently, Devoted Transformations LLC does not provide services to minors. If this should change in the future, an updated consent form reviewing the expectations of guardians will be included.
GUARDIANS OVER ADULTS
Guardians will be expected to be involved in the treatment process. Guardians will be asked to complete all consent forms and be present during the initial assessment as well as the treatment planning process. Guardians will be requested to attend any time the treatment plan is changed or modified as well as if a significant change or event is discussed. Guardians will be updated regularly regarding treatment progress in mutually agreed upon timeframes. Guardians will be expected to be present during discharge planning. While guardians will have access to the client records, it is requested that some privacy be allowed for the client to have ability to create a therapeutic relationship.
CONFIDENTIALITY AND MANDATED REPORTING
By law and in the state of Arizona, social workers are considered mandated reporters. This means that if at any point it is determined that you may be a risk of harm to yourself or others, I am required to break confidentiality to either obtain help for yourself or warn others of your intent to harm them. If I am court ordered to release records, I am also required to break confidentiality. If you have a guardian, I am also required to provide them with updates regarding your care and treatment.
FACILITY OR RESIDENTIAL TREATMENT
If you are receiving services while in a facility or residential treatment setting, you are also authorizing for your records to be shared with the facility. It is understood that information will be exchanged with the facility for quality of care. Once you are discharged from the facility, information will no longer be shared with that facility or residential treatment center.
CLINICAL SUPERVISION
I am independently licensed and do not require clinical supervision. I currently am supervising Danika Batchelor, LAC and Ashley McCann, LAC.
NO CALL NO SHOW POLICY
Please remember to cancel or reschedule your appointments with as much notice as possible. If you miss more than two appointments in a row, you will be removed from the schedule and discharged from Devoted Transformations LLC. If you would like to resume services after you have been removed, it will be required that a new intake and assessment is completed.
TELEHEALTH TREATMENT
Telehealth treatment is offered at Devoted Transformations LLC. Telehealth treatment is a live two-way audio and/or video electronic communications between client and therapist. This allows for clients to have the flexibility of completing sessions outside of an office setting. Clients may opt out of telehealth treatment at any point in time. Telehealth treatment will not be recorded or photographed, and you agree to not record sessions at any point in time. Confidentiality is held at the same standard as in person treatment. Telehealth will be conducted with secure platforms. However, it is important to understand that internet-based communications are not 100% guaranteed to be secure. It is understood that Devoted Transformations LLC will not responsible if any outside parts gains access by bypassing security. It is also understood that interruptions due to technical difficulties may occur. If an emergency arises during a telehealth treatment session, it is understood that the clinician may contact emergency services or your emergency contact. It is understood that all procedures for in person treatment are followed the same for telehealth treatment.
CONSENT FOR TREATMENT
Your signature on this consent form indicates that you have read this consent and are agreeing to have services provided. You are indicating that you have had any pertinent questions answered satisfactorily and agree with services being provided. You are authorizing for Devoted Transformations LLC to begin counseling services with you.