Privacy & Policy

INFORMED CONSENT FOR PSYCHOTHERAPY
In the interest of assuring that you are informed of the conditions of involvement with our services, please be
informed the following:


1. PARTICIPATION IN SERVICES
Treatment is most effective when there are occasional discussions about your progress and counseling experience. You will develop a treatment plan collaboratively with your counselor, and participate in periodic reviews of your treatment and progress, If you feel your treatment is not helping you, please inform your counselor, so that your treatment plan can be revised to most effectively meet your needs.

To further enhance our scheduling system and optimize the availability of therapy services, we have implemented additional policies regarding appointment cancellations and recurring appointments. Please review the following updates:

  1. Reservation of Time: We understand that your time is valuable, and we strive to provide you with the best possible care. Therefore, when you schedule an appointment, the allocated time is reserved exclusively for you. This ensures that you receive the dedicated attention and support you deserve during your therapy sessions.
  2. Cancellation Notice: If you need to cancel an appointment, we kindly request a 24-hour notice in advance. This allows us to offer the time slot to another client in need of therapy services and helps us maintain an efficient schedule.
  3. Session Duration: Individual therapy sessions are typically scheduled to last between fifty to sixty minutes. This timeframe provides an appropriate duration for effective therapy and allows for seamless transitions between clients.
  4. Late Cancellation and No-Show Policy: If you fail to provide a cancellation notice by 8 AM on the day of your appointment and subsequently do not attend the session (no-show), the following consequences will apply:

    a. Cancellation of Recurring Appointments: Any recurring appointments you have scheduled will be automatically canceled. This ensures that the reserved time slots can be made available to other clients seeking therapy services.
    b. Adjusted Appointment Scheduling: If this situation occurs more than twice, you will be required to schedule your appointments on a weekly basis. This allows for more flexibility in scheduling and helps us accommodate the needs of all clients. In case of repeated instances (three or more times), appointments will need to be scheduled on a daily basis.

We understand that unexpected circumstances may arise, making it necessary to cancel or reschedule an appointment. We greatly appreciate your cooperation in providing sufficient notice and adhering to our cancellation policies.

In order to maintain the quality and effectiveness of our therapy services, we have implemented a policy regarding repeated absences or failure to participate in services. Please take note of the following update:

    1. Repeated Absences and Non-Participation: If a client has four or more repeated absences or consistently fails to actively engage in therapy services, it may result in the discontinuation or vacation from services. We understand that unforeseen circumstances may arise, but it is important to prioritize consistent participation to ensure progress and maximize the benefits of therapy.
    2. Assumed Voluntary Termination: In the event that you are not scheduling sessions and/or fail to attend sessions for a continuous period, we will assume that you have voluntarily terminated services with us. Consequently, your client file will be closed. This allows us to maintain accurate records and effectively manage our resources.
    3. New Admission and Intake Process: If your client file is closed due to voluntary termination or repeated absences, you will have the opportunity to participate in another intake and assessment process if you choose to resume therapy services in the future. This process will be considered a new admission, ensuring that we have updated and relevant information to provide you with the best possible care.

A returned check fee of $35 will be applied to your bill for all returned checks. If you do not have insurance or your insurance should lapse for any reason, you will be required to pay the sliding scale fee, calculated by your income. You can set up monthly payments with the billing department.


2. DIAGNOSIS
If you are eligible for services through Plum Behavioral Health, you meet criteria for a qualifying diagnosis. We are required to give a diagnosis to document that you meet criteria for services. Your clinician will discuss your diagnosis with you, and how you meet criteria for the diagnosis. Note a diagnosis is a representation of presenting issues, and is something that is experienced on a continuum. You may meet criteria for a diagnosis during one stage of your life, and not meet criteria at another. It is estimated that a majority of people will meet criteria for a mental health diagnosis at some point in their lives.

3. LIMITS OF CONFIDENTIALITY

a. In accordance with State and Federal laws, Behavioral Health staff are legally obligated to make a report to the appropriate entities if they have reason to suspect the following:

· A child is in danger of abuse or neglect. 

· An elder (65 years or older) is in danger of being abused or neglected. (Note, for elders, financial abuse is considered a form of abuse).

· Someone appears to be in imminent danger of harming themselves or others.

b. Your mental health record can be subject to a legal subpoena in a legal proceeding.

c. If you are paying for services through your insurance company, we are obligated to let your insurance company know your diagnosis and, in some cases, details of your treatment, as a condition of insurance reimbursement.

d. Our clinicians meet with colleagues weekly for Consult with a consultation team. Therapists and mental health professionals on my consultation team with which I work and consult are bound by law to maintain confidentiality and to protect confidential information. All client records are maintained according to HIPAA* regulations and ethical guidelines. 
*Please see our website PlumBHS.org for a copy of the HIPAA Confidentiality and Privacy Act/Rules. 

If your clinician is out of town, they may reveal your/your child’s identity and confidential information about your situation to a therapist that is covering for them.

e. DBT offers Phone Coaching for DBT-IOP enrolled clients. The phone coaching responsibilities may be shared with a Plum BHS therapist other than your therapist. The Plum BHS therapist is a therapist that is on a consult team with your therapist and one that has full knowledge of DBT skills and techniques. I agree that my therapist may reveal necessary information about me or my child for the purposes of crisis coverage if my therapist is not available.

f. Plum BHS works with a variety of contractors in order to expedite the documentation process and other administrative tasks. In these circumstances, our contractors are bound by confidentiality and nondisclosure agreements, which are enforceable by law.

4. SOCIAL CONTACT WITH MENTAL HEALTH STAFF

Note it is against professional Codes of Ethics to engage in social relationships with clients or former clients. If your counselor or another mental health employee sees you in public, you are welcome to initiate a conversation. They may avoid initiating a conversation with you or greeting you, in order to protect your privacy. If you wish to discuss your case, please contact your counselor at the office during regular business hours. We avoid discussing confidential matters in public.


5. GRIEVANCES

You may file a grievance if you are dissatisfied with our service. The information described below regarding filing grievances is posted in our waiting room. You may call any of the following entities to register a complaint: Antwion Butler Plum Behavioral Health Services LLC LLC, Operations 877-758-6328 ex. 7 or Minnesota Board of Behavioral Health (612) 548-2177.


6. CLIENT RIGHTS

Your rights as a client of Plum Behavioral Health include the following:

  1. The right to be treated with respect and with due consideration for your privacy.
  2. The right to receive information on available treatment options and alternatives presented in a manner understandable to you.
  3. The right to participate in decisions regarding your health care, including the right to refuse treatment.
  4. The right to file a grievance or appeal a decision without being subject to discrimination or penalty.
  5. The right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
  6. The right to request and receive a copy of your health Information.
  7. The right to request that your health record be amended.


7. CAUSE FOR DISCHARGE

If it appears that the services we offer are not beneficial for you, a decision could be made to discontinue services.

  1. Failure to treat other clients and staff with respect can result in discharge from program services.
  2. Failure to maintain the confidentiality of others accessing services can result in discontinuation of services.
  3. Plum Behavioral Health reserves the right to discharge clients for reasons not mentioned in this informed consent, should the need arise. Such dismissal from services would not happen without good cause.

8. WEAPONS
Individuals are prohibited from possessing guns at specific locations within Plum Behavioral Health Services LLC, as indicated by posted signage. This policy does not apply to law enforcement officers who are acting in the line of duty.


9. FOLLOW-UP
After completing our services or programs, a representative from Plum Behavioral Health Services LLC may reach out to you or send a survey by mail. Your participation in the follow-up client satisfaction survey is entirely voluntary. We value your feedback, as it helps us continuously improve and optimize our services.

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