Purpose of Treatment
The purpose of meeting with a Behavioral Health Manager is to get help with problems in your life that are bothering you or that are keeping you from being successful in important areas of your life. It is important to take care of both your mind and your body. Your BHM will ask questions, listen to you and suggest a plan for improving these problems.
As a general rule, BHMs will keep the information you share with them in sessions confidential. There are, however, important exceptions to this rule that are important for you to understand before you share personal information. In some situations, BHMs are required by law or by the guidelines of the profession to disclose information whether or not you have given your permission.
It is also possible that family members will receive services from the same BHM. In these situations, your BHM will encourage you to use your session to focus on your own life issues. Your BHM will not disclose information from a family member’s session.
Exceptions to Confidentiality:
▪ In your doctor’s office, we work together as a team. Therefore, your information may be shared with your provider and/or with our psychiatric consultant, for treatment purposes.
▪ You tell your BHM that you plan to cause serious harm or death to yourself, and your BHM believes you have the intent and ability to carry out this threat in the very near future.
▪ You tell your BHM that you plan to cause serious harm or death to someone else who can be identified, and your BHM believes you have the intent and ability to carry out this threat in the very near future.
▪ You tell your BHM that a minor is being abused physically, sexually or emotionally, or has been in the past. Your BHM is required by law to report the abuse to the Department of Child Safety and possibly the police.
▪ Supervision and consultation. Clinical Manager/Supervisor: Dr. Andrea Durand 480.690.8941
▪ All other discussions will occur only when a Release of Information Form has been completed, identifying who the information is to be released to and what specific information is to be released.
Relationship with the Behavioral Health Manager:
The relationship between you and your BHM will be limited to the relationship of BHM and patient only. There are important differences between treatment and friendship. Friends may see your position only from their personal viewpoints and experiences. Friends may want to find quick and easy solutions. A BHM offers you choices and helps you consider what is best for you. BHMs are required to keep the identity of their patient confidential. Therefore, your BHM may not acknowledge you when you meet in a public place and must decline to attend your family’s gatherings if invited. Lastly, when treatment is completed, your BHM will not be able to be a friend to you like your other friends. Your BHM’s duty is to care for you and other patients, but only in the professional role of BHM. Your BHM is not permitted to give or to receive gifts from patients except tokens with personal meaning to the treatment process.
Treatment Risks and Benefits:
Approaches that are commonly utilized by your BHM include cognitive behavioral therapy (CBT), motivational
interviewing (MI) and dialectical behavior therapy (DBT). At times, and if deemed clinically appropriate and necessary, your BHM may administer a variety of screening and assessment tools. Your signature indicates your consent to allow your BHM to administer these instruments as clinically indicated.
Treatment goals are identified and discussed with you after the initial meeting, and as a patient it is your responsibility to participate in working toward the goals set. Emotional risks involved in treatment include disclosing personal feelings, talking about life experiences which may at times be painful or upsetting, asking for help and assistance, expressing emotions such as affection, anger, fear, and sadness, receiving emotional support, and receiving positive and constructive feedback. In addition, there is the potential for therapeutic services rendered to result in no benefit to the patient.
Tele Behavioral Health
May include sessions completed via phone or video utilizing various technologies to provide services when the BHM and patient are in different locations. Systems will be in place to protect patient’s information and confidentiality. There are inherent confidentiality risks with electronic communication and potential for technology failure. The BHM will establish an emergency procedure with the patient should the need arise during a tele behavioral health visit.
When your identified goals have been attained, then you will collaborate to identify a plan through which services can be closed in a manner that is supportive and therapeutic for you. At times changes in eligibility will impact a patient’s healthcare coverage. In the event that a change in eligibility occurs, you will be notified of this change and offered the opportunity to continue services on a private pay basis until eligibility can be restored. Should you be unable to pay this fee, a referral will be made for alternative free or low-cost mental health services that may be available to you.
It is your responsibility to ensure that sessions are kept. If you are not able to attend a pre-scheduled session, you are to contact your provider’s office at least 24 hours before your session to cancel or reschedule.
All of your records will be kept in a secure location. If you would like a copy of any records, please follow the procedure of your doctor’s office to request records.
Afterhours Resources and Emergency Response
Should a life-threatening emergency develop at any time, please contact 911. For an urgent, but non-life-threatening matter that arises during normal business hours, please contact your BHM for guidance and assistance. For assistance and support on weekends and after regular business hours, please contact the Crisis Line: 800-273-8255 (National Line)
Please sign below to indicate your understanding of, and agreement with, the terms and conditions set forth in this Informed Consent document as they pertain to treatment and the risks inherent thereof.