• Children's Advocacy Center
    Serving Bastrop, Lee & Fayette Counties

  • THERAPY AGREEMENT and INFORMED CONSENT NOTIFICATION

  • The Children's Advocacy Center (CAC) is committed to providing high quality services to the children and families we serve. Please review the following information with a CAC therapist. If you have questions, please speak with the therapist directly before signing.

  • CONFIDENTIALITY: All therapy sessions and written records are confidential with few exceptions as outlined below and will only be available to the clinical staff and Executive Director of CAC. If your therapist utilizes clinical supervision/consultation with professionals outside of this Center, they will discuss this with you when you sign your consent for treatment.

  • There are legally mandated EXCEPTIONS which require breaking confidentiality and do not require your permission:
  • 1. CLIENT AUTHORIZATION: Clients can give written consent for CAC to provide information to others (e.g., psychiatrists, doctors, case workers, etc.) in an effort to coordinate treatment.
  • 2. In the instance of a person's safety, the therapist, AS REQUIRED BY LAW, will need to make a report to an appropriate agency. These instances are:
    a. ABUSE OR NEGLECT: If there is reason to believe that a child or elderly person has been or is going to be harmed, Child or Adult Protective Services will be called.
    b. IMMINENT RISK OF HARM: If there is reason to believe that an individual may be at imminent risk of harming self, others, and/or property, then the counselor has the legal and ethical option to call the appropriate authorities. This includes if an individual is actively suicidal, or threats are made against another person. Law enforcement can also be notified and/or summoned.

  • 3. ORDERS FROM COURT OF LAW & CRIMINAL PROCEEDINGS: If there is a court order to release information on records, as is sometimes practiced in legal proceedings, the agency and staff are legally bound to comply with the request. For those cases in which there is a legal case pending, the therapist may be served by a subpoena to provide clinical records or testify in court. The therapist will consider the request for information regarding the client. If the request is in the child's best interest, the therapist will ask the parent/legal guardian to sign a release of information allowing him or her to share case information during the proceedings.

    If a release is not available or the therapist believes providing the information would be harmful to the client, the therapist may still be court ordered to share information. In this case, the therapist will be required to answer questions the court may ask. Only information asked by the court will be released in these circumstances.

  • 4. INAPPROPRIATE BEHAVIOR BY PREVIOUS THERAPIST: If a client discloses that a previous therapist behaved in a sexually inappropriate manner, then the current therapist is legally bound to report it to the District Attorney's office as well as to the appropriate state licensing board. The client's identity need not be disclosed if he/she does not wish it.

  • APPOINTMENTS: Parents/legal guardians are expected to notify the Center within 24 hours for cancellation. After two missed sessions that are not cancelled in time or rescheduled, it is the CAC's policy to consider termination of therapy services at CAC and provide appropriate referrals for other services. Your

  • Updated: 1/18/2024
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  • Children's Advocacy Center
    Serving Bastrop, Lee & Fayette Counties

  • THERAPY AGREEMENT and INFORMED CONSENT NOTIFICATION

  • child's therapist will discuss this issue with you should this situation arise. If you are more than 15 minutes late, the CAC has the right to cancel your appointment.

  • SUPERVISION:

  • Parents/legal guardians are responsible for supervision of children ages 0-14 while at CAC. Parents are to remain at CAC during their child's session so that they are available in their child's treatment as needed.

  • THERAPY:

  • Services Provided

  • The Clinical Department of CAC utilizes a strength based, client-centered approach to therapeutic services. The purposes of the therapy services available at CAC are to help children and families to recover in the aftermath of a traumatic event. A CAC therapist will work with clients and parents/legal guardians to develop a treatment plan that specifically addresses the client's needs. Types of therapy offered include individual, group, family and play therapy. CAC is able to offer these services in a short-term crisis-stabilization model as well as offer long-term therapeutic services. Individual sessions will generally range from 30 to 50 minutes. The therapist will meet with family members on the initial visit and periodically throughout the term of counseling to discuss progress and/or to provide other support. The length of therapeutic services will be agreed upon collaboratively between all the signers of this Therapy Agreement with each client's individual needs and goals in mind.

  • Potential Risks

  • In the course of a child receiving therapy services, it is possible that issues that have remained unspoken for a long time will begin to emerge. As a result of the child processing some of his/her thoughts and feelings, he/she and/or the family may show behavioral indicators of stress. Parents/legal guardians are encouraged to pay attention to these behaviors and talk to your child's therapist if there are any significant changes in the client.

  • Communication

  • Communication is a vital part of CAC's therapy services. Your child's therapist will make every effort to stay in touch with you, as it is CAC's practice to maintain regular communication with adults that are in the child's life. It is important however, for the person in therapy to feel safe discussing issues that may arise in confidence. In the interest of creating a safe and therapeutic environment for the child to work, it is CAC's practice to maintain confidentiality with the child and consult with him or her before discussing information with family members.
  • Text messaging is a quick and easy mode of communication; however, the CAC cannot guarantee the confidentiality of information shared through text messaging platforms. Text messaging should only be utilized for non-confidential information such as canceling/rescheduling appointments and requesting consultations. By signing the Therapy Agreement, you acknowledge and agree to use text messages for non-confidential communication, and you acknowledge that the CAC will not retain text messages sent or received and these messages will not be included in your clinical file. Text messages containing confidential or clinical information will be deleted in accordance with CAC policy.
  • Updated: 1/18/2024
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  • Children's Advocacy Center
    Serving Bastrop, Lee & Fayette Counties

  • THERAPY AGREEMENT and INFORMED CONSENT NOTIFICATION

  • Text messaging is not continuously monitored and is not appropriate for emergency or urgent mental health concerns. Please note that staff are not available 24/7; text messages will be responded to during standard business hours.
  • View our Privacy Policy and Terms of Service at:
    https://www.childrensadvocacycenter.org/tos

  • After Hours Emergencies

  • CAC counseling staff are not available for after-hours emergencies. Should you or your child experience an event that requires immediate assistance please contact the following resources.
  • 911 for all immediate law enforcement and medical emergencies
    800-841-1255 Bluebonnet Trails 24 hour local hotline for mental health crisis
    800-273-TALK (8255) National Suicide Prevention Lifeline

  • Client/Therapist Relationship

  • Although clients may be sharing very personal information during counseling sessions, it is important to remember the professional nature of the therapeutic relationship. CAC's experience demonstrates that clients are best served if the client-therapist relationship remains professional; therefore, sessions and contact are limited to those that support the goals identified in the treatment plan. Note, this includes no contact through any social media platforms, (i.e., Facebook, snapchat, Instagram).

  • TERMINATION: Parents and legal guardians of minor clients have the right to terminate services with the CAC whenever they choose. However, should therapy be discontinued too soon, the child and family can experience a great deal of emotional stressors that may potentially harm their well-being. For this reason, it is recommended that therapy services continue until all signers of the Therapy Agreement have decided termination is appropriate. If you are concerned about the progress of therapy, you are encouraged to speak directly with your child's therapist and/or the Chief Clinical Officer.

  • RECORD RETENTION: Custodian of record for all files within the CAC is the Executive Director. Counseling records for adult clients (18 years of age and older) at the onset of services will be destroyed 7 years after termination. Counseling records for minor clients (17 years of age and younger) at the onset of services will be destroyed 5 years after the client's 18th birthday as per Texas Behavioral Health Executive Council.

  • ALTERNATIVES/REFERRALS: In order to request a transfer to a different therapist, please see your child's therapist or the Chief Clinical Officer at the Center directly. Referrals can be made to another therapist or intern at the CAC or to a therapist in the community. There are times when children and families require or desire therapeutic treatment beyond that which is available at this CAC. In these instances, clients will be referred to other agencies or professionals.

  • Updated: 1/18/2024
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  • Children's Advocacy Center
    Serving Bastrop, Lee & Fayette Counties

  • THERAPY AGREEMENT and INFORMED CONSENT NOTIFICATION

  • CLINICAL STAFF: Therapists each have a Master's degree and are licensed in the state of Texas. CAC is also a training facility and has interns who are currently working towards their Master's degrees. All interns are supervised by experienced, licensed therapists as required by the state of Texas Licensing board. Psychoeducational therapeutic groups can be facilitated by both Master's and Bachelor's interns and licensed staff as required by the Texas State Licensing board.

  • Stacey Helm, LPC-S, LSOTP, NCC
    LPC-S License #62725, LSOTP License #99836
    Ashley Pattillo, LPC-Associate License #95503
    Supervised by Stacey Helm, LPC-S License #62725
    Kelly Gilleland, PhD, LPC-S, LSOTP-S, NCC
    LPC-S License #72661, LSOTP-S License #99469

  • Sarah Moreno, LPC, NCC – License #80546
    Franco Weaver, LPC, NCC – License #81843

    Brittney Sartor, LMSW – License #51814
    Matthew Robbins, LPC License #9323
    Katie Gross, PhD, LPC-S – License #68505

  • COURT SERVICES: All criminal court services will be provided to the client/victim at no charge. Civil court case fees will be the responsibility of the party processing the subpoena. Fee rate is as follows: $250 an hour with a four-hour minimum, subsequent time needed for the case will result in $200 an hour. Time begins at the arrival at the courthouse and ends when the judge releases the witness. Travel will be charged by the mile based upon the current federal reimbursement rate. Minimum rate must be paid prior to the start of court proceedings. Communication with all parties involved will be included as billable hours in half hour increments with a minimum of 30 minutes. Should your therapeutic services be rendered by an LPC-associate all CAC fees along with the fee schedule of the LPC-Supervisor will be collected prior to the court proceedings. All remaining balances will be invoiced within 30 days of service. No further legal services will be rendered until all balances are paid in full. Less than 24-hour notice of cancellation will result in a charge for the 4-hour minimum to cover time spent preparing testimony and cancellation of daily appointments. Should you have any questions regarding the fee schedule please feel free to contact the CAC Chief Clinical Officer at 512-321-6161.

  • Emergency Contact

  • CAC requires that you give us contact information for a person we can contact in case of emergency. This contact will only be used if we believe you or someone else is in immediate danger and unable to continue or depart therapy without assistance.
  • Format: (000) 000-0000.
  • Updated: 1/18/2024
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  • Children's Advocacy Center
    Serving Bastrop, Lee & Fayette Counties

  • THERAPY AGREEMENT and INFORMED CONSENT NOTIFICATION

  • Complaints:

    If at any time you feel you or your child's counseling needs are not being met, please contact our Chief Clinical Officer, Stacey Helm at 512-321-6161 or via email at stacey.helm@cacbastrop.org. For concerns regarding professional misconduct you may also contact the Texas Behavioral Health Executive Council.

  • Texas Behavioral Health Executive Council
    George H.W. Bush State Office Building
    1801 Congress Ave., Ste. 7.300
    Austin, Texas 78701
    Main Line (512) 305-7700
    Investigations/Complaints 24-hour, toll-free system (800) 821-3205

  • I have read and understand the terms of the Therapy Agreement. Furthermore, I acknowledge that I have been given the opportunity to discuss and ask questions regarding the content of the Therapy Agreement.

    I understand that my signature below indicates that I agree to receive therapy services for my child/ren and/or myself and consent to the terms presented.

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  • Updated: 1/18/2024
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