SERVICES PROVIDED

TCTI offers a variety of individual, couples, and family Employee Support Services provided by a variety of mental health professionals.

Employee support services are covered through your employer.  If you are not covered through your employer, payment is expected at the time services are rendered unless you make other arrangements with TCTI’s accounting department.

CONFIDENTIALITY

In keeping with ethical standards of the American Psychological Association and state and federal law, all services provided by the staff of TCTI are kept confidential in the accompanying Notice of Privacy Practices.  As required by mental health professional practice guidelines and current standards of care, we keep records of your sessions. 

Mental health professionals have a legal responsibility to disclose client information without prior consent when a client is likely to harm himself/herself or others unless protective measures are taken, when there is reasonable suspicion of abuse of children, dependent adults or the elderly, when the client lacks the capacity to care for him or herself and when there is a valid court order for the disclosure of the client files.  Fortunately, these situations are infrequent.  Please consult with your mental health professional if you have any questions about confidentiality.

THERAPY POLICIES

TCTI arranges your initial session promptly, but if you consider your situation an emergency you need to inform our staff at the time of making the appointment.   

Many issues typically encountered by TCTI staff can be addressed with the short-term therapy we provide.  Your initial session is an assessment session, devoted to defining your concerns, developing a treatment plan, and determining whether TCTI can meet your needs. 

If at any point it is determined that other services are more suitable, we will help you obtain assistance from appropriate providers.  These providers are not covered by your Employee Support Services program.

Since the scheduling of a session involves the reservation of time specifically for you, please provide us a minimum of 24-hour notice for cancellation of session(s). The Counseling Team International has a 24-hour answering service for your convenience.  If a 24-hour notice is not given, a $60 no-show fee may be charged.

You understand that on occasion your mental health professional may be called out on a crisis situation and this may result in a reschedule of your session(s).  If this occurs, TCTI apologizes for any inconvenience this may have caused you.

Our goal is to provide the most effective employee support services.  If you feel your mental health professional is not a good match for you, we encourage you to discuss this matter with your current mental health professional and ask to be referred to another member of TCTI.  Alternatively, you can speak with the Director of TCTI.  Either of the above can facilitate a transfer to a different mental health professional, if necessary. 

If you have questions or comments about our services, please ask at your initial session or fill out the “We Need Your Help” survey. 

USE OF ELECTRONIC MAIL AND TEXT MESSAGING

Please be aware that e-mail and text messaging may not be private or confidential and may not be read by the recipient in a timely fashion. 

NOTICE TO CLIENTS

The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors. The Department of Consumer Affairs’ Board of Psychology receives and responds to questions and complaints regarding the practice of psychology. You may contact the Board of Behavioral Sciences online at www.bbs.ca.gov, or by calling (916)574-7830. You may contact the Board of Psychology online at www.psychoboard.ca.gov, or by calling 1(866)503-3221.

Please sign below to indicate that you understand and agree to participate in the employee support services in accordance with the above policies.

Summary: By law, we are required to provide you with our Notice Privacy Practices (NPP). This Notice describes how your medical information may be used and disclosed by us. It also tells you how you can obtain access to this information.

We May use and disclose your mental health information: 

To individuals involved in your care, such as your parents, if you are a minor, or your conservator. 

With your written authorization we may use or disclose mental health information for purposes not described in this notice only with your written authorization. 

We may use your mental health information for other purposes without your written authorization:

As required by law when required or authorized by other laws, such as the reporting of child abuse, elder abuse or dependent adult abuse.

To prevent a serious threat to health or safety of an individual.  We may notify the persons, tell someone who could prevent the harm, or tell law enforcement officials.

To protect certain elective officers including the President, by notifying law enforcement officers of potential harm. 

 

As a client, you have the following rights:

1.  The right to inspect and receive a copy of your information;

2.  The right to request corrections to your information;

3.  The right to request that your information be restricted;

4.  The right to request confidential communications;

5.  The right to report disclosures of your information; and

6.  The right to a paper copy of this Notice.

 
We want to assure you that your medical/protected health information is secure with us.  This Notice contains information about how we will insure that your information remains private. 
 
If you have any questions about this Notice, you may contact 1-800-222-9691.

Acknowledgment of Notice of Privacy Practices

“I hereby acknowledge that I have read this copy of practice’s NOTICE OF PRIVACY PRACTICES. I understand that if I have questions or complaints regarding my privacy rights that I may contact the person listed below. I further understand that the practice will offer me updates to this NOTICE OF PRIVACY PRACTICES should it be amended, modified or changed in any way.”

If you think your emotional/stress problems are related to your job, we would be happy to discuss your situation with you and answer questions you may have regarding your rights and benefits under Workers’ Compensation, however The Counseling Team International does not do Workers’ Compensation claims.

I do not wish to make a claim for Workers’ Compensation Benefits at this time. I do not waive my Workers' Compensation Benefits.

Due to the nature of our business, please understand that on occasion your mental health professional may be called out on a crisis situation and this may result in a reschedule of your session(s). If this occurs, TCTI apologizes for any inconvenience this may cause you.

The counseling service provided by your Employee Support Services program is expected to be Short-Term. Please have your Mental Health Professional discuss this with you on your first appointment.

Please remember to cancel or reschedule 24-hours in advance. You will be charged $60 if cancellation is less than 24 hours. You may cancel your appointment via scheduling@thecounselingteam.com, or by calling 1-800-222-9691. TCTI has a 24-hour answering service for your convenience.

A $25 service charge will be charged for returned checks.

For several years, the State of California has recognized telehealth as a form of delivery of behavioral health services which many clinicians are practicing throughout the state.

“Tele-health”, is defined as a means of delivery for behavioral health and wellness services using technologies such as Zoom or Thera-Link to facilitate the diagnosis, consultation, treatment, and care management while the client and provider are at different locations. Telehealth is usually provided through live videoconferencing through a personal computer or smart phone or via telephone. 

I, _____________________ hereby consent to engaging in telehealth sessions

with _____________________ as part of my psychotherapy. I understand that “telehealth” includes the practice of diagnosis, consultation, treatment, transfer of medical data, and education using audio, video, or data communications. I understand that telehealth also involves the communication of my medical/mental information, both orally and visually, to health care clinicians contracted with The Counseling Team International (TCTI).

I understand that I have the following rights with respect to telehealth:

(1) I have the right to withhold or withdraw consent at any time without affecting my right to future care or treatment or risking the loss or withdrawal of any benefits to which I would otherwise be entitled.

(2) The laws that protect the confidentiality of my information also apply to telehealth. As such, I understand that the information disclosed by me during my therapy is generally confidential. However, there are both mandatory and permissive exceptions to confidentiality, including, but not limited to reporting child, elder, and dependent adult abuse; expressed threats of violence towards an ascertainable victim; and where I make my mental or emotional state an issue in a legal proceeding.

(3) I understand that there are risks and consequences from telehealth, including, but not limited to, the possibility, even after reasonable efforts on the part of my clinician, that: the transmission of my information could be disrupted or distorted by technical failures; the transmission of my information could be interrupted by unauthorized persons; and/or the electronic storage of my information could be accessed by unauthorized persons. In addition, I understand that if my clinician believes I would be better served by another form of psychotherapy services (e.g. face-to-face services) I will be referred to a clinician who can provide these services to me.

(4) I understand that I may benefit from telehealth, but that results cannot be guaranteed or assured.

(5) I understand that I have a right to access my medical information and copies of medical records in accordance with California law.

I have read and understand the information provided above. I have discussed it with my clinician and all of my questions have been answered to my satisfaction.