I am very pleased that you selected me, Shannon D. Mullen. Ph.D., CSAT-S, for your consultation needs, and I sincerely look forward to assisting you. This document provides information about (a) what you can expect from me as your consultant, (b) confidentiality and emergency-related company policies, (c) payment and cancellation notice, and (d) several other details concerning your consultation. Although providing this document is part of an ethical obligation to our profession, more importantly, it is part of my commitment to ensure that you are fully informed of every part of your consultation experience. Please know that your relationship with me is collaborative, and I welcome any questions, comments, or suggestions at any time.

I am passionate about assisting others with their client concerns, learning new skills or areas of practice, and developing their companies (using that business degree!). I've learned so much along my own journey as a clinician in the mental health field and CEO of my practice.

I completed my Ph.D. in Counseling Psychology from The University of Tennessee in Knoxville, Tennessee, in 2008. Postdoctoral training was completed in Forensic Psychology. I am a licensed psychologist in Georgia and Florida and a PSYPACT clinician. PSYPACT allows me to provide services remotely in several participating states in the United States. Before my doctoral studies, I completed a Master of Arts in Counseling at the University of New Orleans. In 2010 I established Mosaic Psychological Services LLC, providing clinical and forensic services.

I have over 20 years of treatment and assessment experience in sexual disorders and addiction. Clinical specialty areas include trauma, attachment, sexual health/addictions, and psychological evaluation. Additionally, as a Certified Sexual Addiction Therapist and Supervisor (CSAT-S), I provide targeted interventions for individuals struggling with sexual infidelity and addiction to sexual material and behaviors. I am also engaged in training new CSAT candidates and Pre and Post doctoral-level psychologists. Treating the whole person is a hallmark of my work, and I approach each person with attention to the physical, emotional, and spiritual dimensions of their personhood.

I am trained in psychodynamic theory and practice through a trauma model utilizing Internal Family Systems. I have been trained as a Level II IFS clinician. Additionally, I am EMDR trained. Finally, as a Catholic Christian, theology is a welcomed addition to this clinical work and forms the psychodynamic lens through which the whole person is restored to dignity and health. In 2022, I was awarded the Catholic Psychotherapy Association's Mother of Good Counsel Clinical Excellence Award. I currently sit on the Board of Directors for CPA as the Past President. I am the lead author of the organization's Ethics Code as the former Chair of the Ethics Committee. Additionally, Bishop Wack appointed me as Victim Assistance Coordinator of the Diocese of Pensacola-Tallahassee in 2022.

I am also a regular speaker and consultant for religious organizations. I regularly design and host training seminars for clinicians in psychosexual assessment and treatment of clergy and clergy applicants. When not engaged in direct patient care and training, I enjoy supervising emerging new mental health professionals.

Georgia License PSY003406 & Florida License PY10361
Authority to Practice Interjurisdictional Telepsychology (APIT)
ASPPB E. Passport for PSYPACT

I'm happy to share any information I've learned over the years with you. I want to help you make the wisest choices, benefit from my experiences and training, and even learn from my mistakes. Ideally, this will help you to serve all the clients that need your specific knowledge and areas of expertise.

I intend to empower you in your practice development and client care. If appropriate and you are comfortable with this, I may ask personal questions about your beliefs regarding self-efficacy and counter-transference. If you do not want to answer a question at any time, please know that I will respect this. My role is that of consultant, not therapist. However, these occasionally overlap when personal issues interfere with your ability to grow your practice and handle clients effectively. If you prefer to explore any of these dynamics elsewhere, that will be completely supported. Your professional development is my number one priority. I am very committed to helping you in whatever way produces maximum benefit.

Your communications with me will become part of a professional consultation record, and I protect it the same as Protected Health Information (PHI). Your PHI will be kept in a file stored electronically, encrypted in a HIPAA-compliant manner with Microsoft 365. Additionally, just like a therapeutic relationship, I will always keep everything you say to me completely confidential, with the following exceptions: (1) you direct me to tell someone else, and you sign a "Release of Information" form; (2) I determine that you are a danger to yourself or others; (3) you report information about the abuse of a child, an elderly person, or a disabled individual who may require protection; (4) you tell me that you have had or are currently having sex with one of your clients because this is considered an immediately reportable offense according to the Georgia and APA ethics codes that I abide by, and I am not your therapist, or (5) I am ordered by a judge to disclose information. If, for some unusual reason, a judge were to order the disclosure of your private information, this order can be appealed. I cannot guarantee that the appeal will be sustained, but I will do everything I can to keep what you say confidential.

Unless you request otherwise, you must know that my administrative assistant or business manager may need to access your chart for business purposes only (e.g., payment information). However, please know this would never include reading any of your notes. Additionally, each of my business associates has signed a HIPAA-enforced confidentiality contract which spells out how confidential records must be handled. If you have any questions about confidentiality, please ask.

Consultation by telephone, email, or a HIPAA-compatible video service is available. My primary means of consultation is using a HIPAA-compliant encrypted video conference using Zoom. Time spent on telephone calls with you or on your behalf, reading and/or writing emails, preparing materials for you at your request, and any other service that you have contracted me to provide will be billed at the hourly rate. This does not include scheduling time. The fee for each session will be

due before our meetings. Cash, personal checks, Visa, MasterCard, Discover, and American Express are acceptable forms of payment, and I will provide you with a receipt of payment. This fee is a tax-deductible expense if consultation is being performed in relation to your business or practice. Please note that there is a $30 fee for any returned check.

I agree to provide consultation for the investment listed below. Please note that while the International Institute for Trauma and Addiction Professionals (IITAP) designates hours accumulated through this process as "supervision" for purposes of CSAT certification, the professional relationship described in this agreement is consultative in nature. You are a fully licensed mental health professional who retains complete and independent responsibility for all clinical decisions made in your practice. This consultation does not constitute clinical supervision for licensure, nor does it create a supervisory relationship as defined by state licensing boards or applicable law.

Investment	Time	Number of Consultees
$195.00	60-Minutes	One Consultee
$120.00 per person	60-Minutes	Dyad (2 Consultees)
$240.00 per person	2 Hours (10-minute break	Dyad (2 Consultees)
$160.00 per person	2 hours (10-minute break)	3 to 6 Consultees

If you cannot keep an appointment, you must notify me at least 24 hours in advance. If such advance notice is not received, you will be financially responsible for the session you missed.

My Practice is considered an outpatient facility, and I am set up to accommodate reasonably safe and resourceful individuals. I do not carry a beeper, nor am I available at all times. If at any time this feels like there needs to be more support, please inform me, and I can discuss additional resources or transfer your case to a consultant with 24-hour availability. Generally, I will return phone calls or emails within 24-48 hours, except for weekends and holidays. If you have an emergency, I encourage you not to wait for a callback but to do one or more of the following:

• Call 911.
• Go to your nearest emergency room.

As mentioned above, I treat the consultative relationship in a way that is similar to a therapeutic relationship regarding confidentiality. I may also occasionally explore personal issues if appropriate, and only with your consent. Therefore, it is important that we maintain a professional relationship. If you and I were to interact in any other ways, we would have a "dual relationship," which could be harmful to you in the long run. As I'm sure you know, this is unethical in the mental health profession. Dual relationships can set up conflicts between the consultant's and consultee's interests, and then the consultee's (your) interests might not be put first. In order to offer all of my consultees the best care, my judgment needs to be unselfish and purely focused on your needs. This is why our relationship must remain professional in nature.

Additionally, there are important differences between consultation and friendship. Friends may see your position only from their personal viewpoints and experiences. Friends may want to find quick and easy solutions to your problems so that they can feel helpful. These short-term solutions may be outside your long-term best interest. Friends do not usually follow up on their advice to see whether

it was useful. They may need to have you do what they advise. I will do my best to offer you choices and help you choose what is best for you. In sum, once I'm a consultant for you, I want to maintain a professional role. If you ever need my services again, I can easily be available to you without complications. Please note that these guidelines are not meant to be discourteous in any way; they are strictly for your long-term protection.

In our ever-changing technological society, we could potentially communicate and/or follow each other electronically in several ways. It is of utmost importance to me that I maintain your confidentiality, respect your boundaries, and ascertain that your relationship with me remains professional. Therefore, I've developed the following policies regarding TeleMental Health:

Cell phones: It is important for you to know that cell phones may not be completely secure or confidential. However, I realize that most people have and utilize a cell phone. And, at this time, there is very little that we can do to make this technology safer. I may use a cell phone to contact you. If this is a problem, please discuss this with me. Please note that phone conversations (other than just setting up appointments) are billed at my hourly rate.

Text Messaging:
Text messaging is not a secure means of communication and may compromise your confidentiality. Furthermore, sometimes people misinterpret the meaning of a text message and/or the emotion behind it. Therefore, I do not use texting in my practice and will not respond to a text message for your protection. If you send me a text message by accident, you need to know that I am required to keep a copy or summary of all texts as part of your consultation record that addresses anything related to consultation,

Email:
I utilize a secure email platform hosted by Microsoft 365 and Zix Encryption. I have chosen this technology because it is encrypted to the federal standard, HIPAA compatible, and has signed a HIPAA Business Associate Agreement (BAA). The BAA means the company is willing to attest to HIPAA compliance and assume responsibility for securing your PHI. If we choose to utilize email as part of your consultation, please respond within the Zix system for encryption of the communication. I also strongly suggest that you only communicate through a device that you know is safe and technologically secure (e.g., has a firewall, anti-virus software installed, is password protected, does not access the internet through a public wireless network, etc.). Email (other than just setting up appointments) is billed hourly for the time I spend reading and responding to them. If you are in a crisis, please do not communicate this to me via email because I may not see it promptly. Instead, please see below under "Emergency Procedures." Finally, you also need to know that I am required to keep a copy or summary of all emails as part of your consultation record that address anything related to consultation.

Social Media: Mosaic Psychological Services, LLC has a business Facebook page. You are welcome to follow the company. However, please do so only if you are comfortable with the general public being aware that your name is attached to mine. Please refrain from making contact with me using social media messaging systems such as Facebook Messenger. These methods have insufficient security, and I do not watch them closely. I would not want to miss an important message from you.

Search Engines: My policy is not to search for my consultees on Google or any other search engine. I respect your privacy and make it a policy to allow you to share information about yourself with me as you feel appropriate. If there is content on the Internet that you would like to share with me for consultation purposes, please print this material out and bring it to consultation, or you are welcome to bring in a laptop or tablet and share it electronically.

In summary, technology is constantly changing, and there are implications to all of the above that we may not realize at this time. Please feel free to ask questions, and know that I am open to any feelings or thoughts you have about these and other modalities of communica

In summary, technology is constantly changing, and there are implications to all of the above that we may not realize at this time. Please feel free to ask questions, and know that I am open to any feelings or thoughts you have about these and other modalities of communication.

Video Conferencing is an option for us to conduct remote consultations over the Internet where we not only can speak to one another but we may also see each other on a screen. I utilize a HIPAA Compliant Video Conferencing Zoom account. This VC platform is encrypted to the federal standard, HIPAA compatible, and has signed a HIPAA Business Associate Agreement (BAA). The BAA means that Zoom is willing to attest to HIPAA compliance and assumes responsibility for keeping our VC interaction secure and confidential. If we choose to utilize this technology, I will give you detailed directions regarding how to log-in securely. I also ask that you please sign on to the platform at least five minutes prior to your session time to ensure we get started promptly. Additionally, you are responsible for initiating the connection with me at the time of your appointment. I strongly suggest that you only communicate through a computer or device that you know is safe (e.g., has a firewall, has anti-virus software installed, is password protected, not access the internet through a public wireless network, etc.).

During the course of our consultation, I may recommend that you visit certain websites for pertinent information. I may also recommend certain apps that could be of assistance to you. Please be aware that websites and apps may have tracking devices that allow automated software or other entities to know that you've visited these sites or applications. They may even utilize your information to attempt to sell you other products. Additionally, anyone who has access to the device you used to visit these sites/apps, may be able to see that you have been to these sites by viewing the history on your device. Ethically, I need to make you aware of the potential risks to your confidentiality. Therefore, it is completely up to you if you'd like to visit these websites or use these applications.

Your communications with me will become part of a consultation record of treatment. My consultation notes will be stored electronically with Microsoft 365, Sharepoint, a secure storage company that has signed a HIPAA Business Associate Agreement (BAA). The BAA ensures that they will maintain the confidentiality of any PHI in a HIPAA-compatible secure format using point-to-point, federally approved encryption. Additionally, PHI will be kept on my password-protected computer in an encrypted file format.

I utilize Bill Flash/Fortis/Stripe as the company that processes your credit card information. This company may send the credit card holder a text or an email receipt indicating that you used that credit card for my services, the date you used it, and the amount that was charged. This notification is usually set up two different ways - either upon your request at the time the card is run or automatically. Please know that it is your responsibility to know if you or the credit card holder has the automatic receipt notification set up in order to maintain your confidentiality if you do not want a receipt sent via text or email. Please be aware that the transaction will appear on your credit card bill. The name on the charge will appear as Mosaic Psych.

By contracting with me for consultation services, you agree to carry full and sole liability for any professional decisions you make, even those informed by the consultation. You are fully aware that this is consultation and not to be construed as supervision. You are agreeing not to hold me or any of my associates legally responsible should any problems or consequences of your professional practice and decision-making occur. You are agreeing that you understand the consultation I give is informed by my training and experience but does not in any way constitute legal advice or take the place of legal counsel and/or accounting advice.

I assure you that my services will be rendered in a professional manner consistent with the ethical standards of APA. If at any time you feel that I am not performing in an ethical/professional manner, please let me know immediately. As much as I would like to guarantee specific results regarding your consultative goals, I am unable to do so. However, together, we will work to achieve the best possible results for you.

I am sincerely looking forward to facilitating you on your journey toward developing and or expanding your practice and/or helping with your clinical population. If you have any questions about any part of this document, please ask me.