Anger Management

Thank you for choosing Step Three, Inc. for your Anger Management course. Please complete the information below. At the end of these documents, you will find helpful information about the class and your invoice. We look forward to having you in the program.

My signature below indicates that the information I provided above is true and complete to the best of my knowledge.

I understand that I am voluntarily enrolling in the Anger Management Program offered by Step Three, Inc. This program is a 10-12 week program that meets once per week.  This program is designed to provide education and skill-building related to anger awareness, emotional regulation, communication, and behavioral decision-making.

I understand that the Anger Management Program is educational in nature and is not intended to diagnose or treat mental health disorders. 

Program Format
I understand that anger management classes will be conducted live via Zoom for 1 hour per week eveery week for the duration of the program. I agree to participate from a safe and appropriate environment with a working camera and audio connection. Participants may be required to keep their camera on and actively participate in the class.

Program Completion

I understand that I have 180 days from the date of registration to complete the anger management program. If I do not complete the program within 180 days, I understand that all fees paid will be forfeited, and I will be required to re-register and pay the full program fee again in order to restart the program.

I understand that in order to receive a completion certificate, I must actively participate in all required classes (10–12 sessions) and pay all program fees in full.

Fees
The fee for the Anger Management Program is $25 per class.
A sliding fee scale is available for individuals who qualify. I understand that fees paid for classes are generally non-refundable once services have been scheduled or provided.

Confidentiality
I understand that Step Three, Inc. will maintain the confidentiality of participant information in accordance with applicable state and federal laws. However, confidentiality may be limited in certain circumstances, including:

• When there is a risk of harm to myself or others
• When abuse or neglect of a child, elderly person, or vulnerable adult must be reported as required by law
• When records are requested through a valid subpoena or court order
• When otherwise required by law

Because anger management classes are conducted in a group setting, I understand that Step Three, Inc. cannot guarantee the confidentiality of statements made by other participants.

Acknowledgment
By signing below, I acknowledge that:

• I have read and understand this informed consent.
• I have had the opportunity to ask questions.
• I voluntarily agree to participate in the Anger Management Program at Step Three, Inc.

Step Three, Inc. shall meet the requirements of all applicable state and federal laws, rules, and regulations regarding the confidentiality of participant information.

Participant records are considered confidential and will not be released to another individual or agency without the participant’s expressed written consent, except in the following circumstances:

• Upon receipt of a valid subpoena or court order
• In the event of a medical or psychological emergency
• When required by state law, including the mandatory reporting of suspected child abuse, elder abuse, or abuse of a vulnerable adult
• When a participant presents an imminent danger to themselves or others

The confidentiality of participant information and records shall be maintained, recorded, released, and provided to requesting parties in accordance with all applicable state and federal laws.

Confidentiality Protections
For purposes of program operations and certification requirements, Step Three, Inc., its staff, and facilitators will comply with applicable confidentiality laws, including 42 CFR Part 2, when applicable, protecting the confidential and privileged nature of participant information.

At a minimum, this includes the following protections:

All anger management program information, whether recorded or not, and all communications between Step Three, Inc. staff, facilitators, and participants are considered confidential and will not be released without the written consent of the participant or the participant’s legally authorized representative, unless otherwise permitted or required by law.

The identity of a participant who has received or is receiving services through Step Three, Inc. is confidential and will not be released without written consent from the participant or the participant’s legally authorized representative, unless otherwise permitted or required by law.

Access to participant records and program information will be limited to authorized staff or agencies with a legitimate need to know, and only the minimum necessary information will be disclosed.

A participant or the participant’s legally authorized representative may request access to their program records in accordance with applicable laws and agency policies.

Certain state and federal laws allow or require disclosure of information without the participant’s consent. In those situations, Step Three, Inc. will release information only as required by law. 

My signature below indicates that I have been informed of my right to confidentiality and understand how my information may be used and disclosed.

 

 All consumers have the right to assert grievances with respect to any alleged infringement on their rights. They have the right to request the opinion of an outside medical or psychiatric consultant at their own expense, or a right to an internal consultation upon request at no expense. No consumer will be retaliated against or subjected to any adverse change of conditions or treatment because they asserted their rights. As stated above, consumers have the right to voice grievances regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect for person and/or property and will not be subjected to discrimination or reprisal for doing so.

If a consumer feels that they have a grievance, they can complete a grievance orally or in writing with Step Three, Inc. They have the right to seek a review thereof with the Director, Misti Luke. A memorandum of the grievance will also be made by the Director, Misti Luke. The grievance should specify any objections or disagreements which the consumer has of Step Three, Inc. Every attempt will be made to resolve the grievance. Should the grievance be resolved, a written report of the actions to alleviate the aggrieved will be provided to the aggrieved consumer. Should the aggrieved consumer not be satisfied with the resolution, the grievance will be forwarded to the Board of Directors by the Director, with staff recommendations for resolution. In any event, the recommended resolution will be provided to the aggrieved consumer within one week of receiving the written grievance. Contact information for the Board of Directors is posted in the lobby of the office.

Complaints may also be directed to the ODMHSAS Office of Consumer Advocacy 2000 N. Classen Blvd. Ste. E6000, Oklahoma City, OK 73106 

ODMHSAS: Office of Consumer Advocacy, E-Mail: AdvocacyDivision@odmhsas.org

Local: (405) 248-9037 Toll Free: (866) 699-6605  Reachout Hotline (800) 522-9054

My signature indicates I have read and understand my rights to file a grievance and have been offered a copy of this document. 

Helpful Information for Class
• All classes are held online using Zoom.
• Any needed class materials will be mailed to the address you provided.
• Please download the Zoom app to your phone before your firstclass.
• A strong and stable internet connection is required.
• You will receive a Zoom link from your facilitator on the day of class.

To attend class, you must:
• Be seated upright with your camera on at all times.
• Be in a quiet location by yourself.
• Be fully clothed.
• Ensure your phone or tablet is fully charged and has a working camera.
• Not attend class while driving or riding in a moving vehicle.

If you have any questions, please contact the office at (580) 584-6622.

Each consumer has the right to be treated with respect and dignity.

Furthermore: Each consumer shall retain all rights, benefits, and privileges guaranteed by law except those lost through due process of law. Each consumer has the right to receive services suited to his or her condition in a safe, sanitary and humane treatment environment regardless of race, religion, gender, ethnicity, age, degree of disability, handicapping condition or sexual orientation.

No consumer shall be neglected or sexually, physically, verbally, or otherwise abused. Each consumer shall be provided with prompt, competent, and appropriate services. A consumer shall participate in his or her services and may consent or refuse to consent to the proposed services. The right to consent or refuse to consent may be abridged for those consumers adjudged incompetent by a court of competent jurisdiction and in emergency situations as defined by law. 

Additionally, each consumer shall have the right to the following:

 To be free from unnecessary, inappropriate, or excessive treatment;  To not be subject to unnecessary, inappropriate, or unsafe termination from services. Every consumer's record shall be treated in a confidential manner.No consumer shall be required to participate in any research project or experiment without his or her informed consent as defined by law. Refusal to participate shall not affect the services available to the consumer. A consumer shall have the right to assert grievances with respect to an alleged infringement on his or her rights.

 No consumer shall be retaliated against or subjected to any adverse change of conditions or services because the consumer asserted his or her rights.

 

ODMHSAS: Office of Consumer Advocacy, E-Mail: AdvocacyDivision@odmhsas.org

 Local: (405) 248-9037 Toll Free: (866) 699-6605  Reach out Hotline: (800) 522-9054

 

My signature indicates I have read and understand my rights and have been offered a copy of this document.