INFORMED CONSENT FOR COUNSELING SERVICES
Member Assistance Program
Employee Assistance Program
Faculty and Staff Assistance Program
Welcome to Christian Family Solutions (CFS). Thank you for choosing us to assist you. We pray that our gracious God works through our skilled counselors to resolve the matters that brought you to us for care.
Christian Family Solutions, founded in 1965, provides Christian counseling care and services in our clinics, in schools, and via secure video. We are committed to healing and helping people in need with the same excellence and unconditional love that Jesus Christ demonstrated in His ministry. It is our hope that you feel welcomed, safe, and supported within our family of care.
It is our prayer that your relationship with your Christian counselor will help you and/or your family members to gain better insight into your daily living and to grow toward a healthier, more satisfying Christian life. This requires mutual effort by both you and your counselor. Change does not happen by itself; we would fail without the strength of our gracious Lord. Living the Christian life is both a joy and a challenge for all of us.
Service Options
Member Assistance Program
Through our Member Assistance Program (MAP) we partner with congregations and schools and provide short-term support for members. Each congregation or school designs their program in a unique way to support their members and help create and maintain a healthy congregational organization. Most plans require a referral from the pastor or principal, and we ask members to sign a Release of Information form so the counselor can communicate with the referral agent to provide updates as needed. Check with your pastor or principal for specific details on your plan.
Employee Assistance Program
The Employee Assistance Program (EAP) is similar to MAP except we partner with Christian businesses to provide short-term support to employees. Each business designs their program in a unique way to support their employees and ultimately help to create and maintain a healthy workforce and organization. Most EAP organizations do not require a referral or a release form. Check with your Human Resource Manager for specific details on your plan.
Faculty and Staff Assistance Program
Through our Faculty and Staff Assistance Program (FSAP) we partner with Christian schools and provide short-term support for members of the school faculty or staff. Each school designs their program in a unique way to support their faculty and staff members and ultimately help to create and maintain a healthy school organization. Many plans require a referral from their principal and we ask members to sign a Release of Information form so the counselor can communicate with the principal to provide updates as needed. Check with your principal for specific details on your plan.
The counseling services available through these plans are intended to be short-term and non-clinical. The intention is to help assess your program situation, provide short-term problem resolution, refer to longer-term support if needed, and follow up on your approaches to change. The services are provided by mental health professional who are interns, in-training counselors, or those who have their license. Although the counselors you may meet with are licensed mental health professionals, the type of support provided through MAP, EAP, or FSAP is non-clinical. If you and your counselor determine there is a need for a clinical level of care, such as outpatient therapy, intensive outpatient therapy, day treatment services or other higher levels of care, you and your counselor will explore resources that will best meet your needs.
Your organization defines the session limit and services that are available to you at no cost. Should you and your counselor identify a longer-term need, you may continue meeting with your counselor through our outpatient services if that provider is licensed in your state, or your counselor will help you find resources to meet your needs.
Services are available in person at one of our Christian Family Solutions clinics, or through a secure video connection.
The following is important information related to the counseling services you are agreeing to receive through Christian Family Solutions, including the process of counseling and our mission statement. If you receive services through a secure video connection, please read the information related to telehealth. Please read it carefully and feel free to ask questions about anything that is not understandable. The purpose of this Informed Consent is to ensure that our relationship with you is founded on understanding and trust. You will be asked to sign an Acknowledgment Form, indicating that you understand and agree with the terms of this Informed Consent.
The Process of Counseling
The focus of our support and counseling services in our Member Assistance Program, Employee Assistance Program, or Faculty and Staff Assistance Program is meant to provide members, employees, or faculty members the opportunity to share their personal, work, or family concerns and be encouraged with a Christian approach that emphasizes God's love and his strength.
"For I, the LORD your God, hold your right hand; it is I who say to you, 'Fear not, I am the one who helps you." Isaiah 41:13
This passage from Isaiah sets the tone and approach for our counseling services. Your counselor will help you assess your problem situation, provide short-term counsel, and point you to the Lord’s work in your life through the challenges you face. For counseling services to be most effective, it is helpful to have a collaborative relationship with your counselor and a sustaining relationship with the Lord as he blesses and leads to process of change.
The counseling services available in the Member Assistance Program, Employee Assistance Program, or Faculty and Staff Assistance Program have both benefits and risks.
- The benefits of short-term, supportive counseling services have been shown to reduce feelings of distress, create better relationships, and resolve specific problems. A unique Christian counseling approach encourages the use of God’s Word and can also lead to closer relationship with the Lord leading to significant reductions in feelings of distress.
- Risks include experiencing uncomfortable feelings such as sadness, guilt, anxiety, anger, loneliness, and helplessness that may be part of the process of change. Relationships may also be affected. Should you choose to not pursue counseling or discontinue prematurely against your counselor’s advice, your symptoms may return and/or worsen.
Your experience may be similar to or vary from those described above.
There are four main steps in the counseling approach used in our programs:
- The first step is assessment. You and your counselor will spend time evaluating your needs and your goals and gathering pertinent information. A plan will be completed that will include goals for change, and intervention techniques needed to accomplish these goals. These techniques may involve exploring resources such as books, websites, support groups, pastoral counseling, or clinical-levels of care. Any questions you have about the process of assessment and planning should be discussed whenever they arise.
- The second step is short-term problem resolution. The first step is usually covered in the first session. The number of sessions needed to accomplish goals will vary depending on the number of sessions provided by your organization, the complexity of problems you are facing, and the availability of resources.
- The third step is referral. Some matters are quite complex and beyond the scope of the short-term counseling services available through your Member Assistance Program, Employee Assistance Program, or Faculty and Staff Assistance Program. Considerable time may be needed to accomplish some goals. Those with issues related to self-harm, suicide, or legal matters (i.e. child custody determination, marital dissolution) will receive a referral to a clinical service. However, other situations take less time to resolve. Your counselor will make every effort to be as time and cost efficient as possible to help you resolve your areas of concern. If your assessment in step one indicates that a clinical level of care is appropriate for your situation, you and your counselor will explore options either within the CFS family of services or to the provider that best fits your needs.
- The last step is follow up. If your specific program in your organization requires a referral, your counselor will collaborate with your authorizing agent to provide updates with your written permission. In this way, your pastor, principal, or other organizational support contact can follow up with you and provide continuing support to make sure the changes you have made are being maintained. In some cases, your organization may wish to use your counselor at CFS to provide follow-up contact with you as well.
Emergency Coverage
In cases of a mental health emergency or "after hours" coverage, please call 800.438.1772 and follow the prompt to be connected with a professional counselor immediately. For life-threatening situations, please call 911 or go to your nearest hospital.
Confidentiality
The counseling relationship is confidential. Your counselor cannot release any information about the counseling process without your written permission. This includes even the fact that you are receiving services through Christian Family Solutions In all our programs, the relationship with your counselor is important. Confidentiality is a key aspect of a trusting relationship and we will maintain that confidentiality through all our operations in order to maintain that trust. A copy of our Privacy Practice Notice is available in writing upon request.
Confidentiality does have legal and ethical limitations. A counselor may break confidentiality if, in his/her judgment, it is necessary to protect the safety or welfare of the client or another person. If you threaten to hurt yourself or someone else, or raise suspicion of child abuse, or if a minor under the age of 16 reports sexual activity, your counselor may be bound by law to report it to the proper authorities.
Your counselor may discuss your case with other Christian Family Solutions professional staff including contracted consultants for purposes of effectively coordinating treatment and/or to meet state-mandated requirements.
Christian Family Solutions uses professional counseling staff including interns, in-training counselors, and licensed staff. Many of these staff members also provide outpatient clinical mental health services in one of our state-certified mental health clinics and are obligated to maintain clinical records in accordance with the respective administrative rule. The counselors who serve in Member Assistance Program, Employee Assistance Program, or Faculty and Staff Assistance Program use a similar electronic record of activity that is confidential and kept within a secure software system developed specifically for the counseling industry. All records are not only secure; they also have a redundant backup system in the event of a system malfunction. Only authorized personnel have access to these electronic records.
Supervision and Consultations
If a referral was required as part of your organization's agreement, you may be asked to sign a release so that your counselor can consult with the referral agent. You have the right to refuse to sign a release if you would prefer. Without a signed release, a counselor may not be able to request additional sessions from the referral agent if needed.
As part of your counselor's ongoing professional development, he/she may be receiving supervision. Your counselor will inform you at your first meeting if he/she is being supervised.
Fees
Your sessions provided to you through your organization's Member Assistance Program, Employee Assistance Program, or Faculty and Staff Assistance Program are available to you at no cost. The number of sessions or hours of service depends on your organization's program limits. If you choose to continue meeting with your counselor and utilize clinical services after your organizational counseling benefit has been reached, and you reside in a state where your counselor is licensed, you will be responsible for fees associated with those services. You will receive information about that process if you choose to utilize ongoing clinical services needed to address a longer-term concern. Referrals to a clinical provider or resource outside of Christian Family Solutions will be handled according to the policies and procedures of that clinical external resource and fees associated with those services are your responsibility.
Counseling Services Through Secure Video
Counseling services provided through a secure video connection is also called telehealth. You can utilize telehealth services both through Christian Family Solutions’ outpatient services as well as through your organization’s Member Assistance Program or Employee Assistance Program.
Telehealth involves the use of electronic communications to enable Christian Family Solution’s mental health professionals to connect with individuals using interactive video and audio communications. Telehealth includes the practice of psychological health care delivery, and may include diagnosis, consultation, treatment, referral to resources, education, and the transfer of medical and clinical data.
You have the following rights with respect to telehealth:
- The laws that protect the confidentiality of your personal information also apply to telehealth. As such, the information disclosed by you during the course of your sessions is 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 toward an ascertainable victim; and where you choose to make your mental or emotional state an issue in a legal proceeding. The dissemination of any personally identifiable images or information from the telehealth interaction to other entities shall not occur without your written consent.
- You can choose to withhold or withdraw your consent to the use of telehealth in the course of your care at any time, without affecting your right to future care or treatment.
- There are potential risks and consequences from receiving services through telehealth, including, but not limited to, the possibility, despite reasonable efforts on the part of the counselor, that: the transmission of your personal information could be disrupted or distorted by technical failures, the transmission of your personal information could be interrupted by unauthorized persons, and/or the electronic storage of your personal information could be unintentionally lost or accessed by unauthorized persons. Christian Family Solutions utilizes secure, encrypted audio/video transmission software to deliver telehealth.
- If your counselor believes you would be better served by another form of intervention (e.g., face-to-face services), alternatives to counseling through telehealth will be explained to you and you will be referred to a mental health professional that can provide such services in your area. Once referred to an outside provider, it is your responsibility to pay for services received from that provider.
- There are potential risks and benefits associated with any form of counseling, and that despite your efforts and the efforts of your counselor, your condition may not improve, and in some cases may even get worse.
- In choosing to participate in telehealth, you are agreeing to participate using video conferencing technology. However, at your request or at the direction of your counselor, you may be directed to "face-to-face" psychotherapy.
- You may expect the anticipated benefits such as improved access to care and more efficient evaluation and management from the use of telehealth in your care, but that no results can be guaranteed or assured.
- Others may also be present during the counseling session other than your counselor in order to operate the video equipment. If others are present, they will be identified to you at the beginning of the session and will all maintain confidentiality of the information obtained. When others are present in the session, you have the right to request the following: (1) omit specific details of your medical history that are personally sensitive to you, (2) ask non-clinical personnel to leave the telehealth room, and/or (3) terminate the session at any time.
- For your safety, you will be asked by your counselor to confirm your physical location during the session. Certain situations, including emergencies and crises, are inappropriate for audio-/video-/computer-based psychotherapy services. If you are in crisis or in an emergency during your session, your counselor will contact emergency services in your area, or ask you to immediately call 9-1-1 or seek help from a hospital or crisis-oriented health care facility in your immediate area.
- Information about your counselor, including a written and video biography with details on their credentials and training, is provided on our website ChristianFamilySolutions.org.
Mission Statement and Statement of Beliefs
Mission Statement
Healing and helping people in need through the ministry of Jesus Christ
Statement of Beliefs
- We believe in the Triune God, one God eternally existent in three persons: Father, Son, and Holy Spirit (Matt. 28:19).
- We believe that the Bible is the inspired (2 Pet. 1:21), inerrant (1 Cor. 2:13), infallible (Jn. 10:35), and completely authoritative (2 Tim. 3:16) Word of God.
- We believe that all people are sinners by nature and activity (Ps. 51:5) and unable to reconcile themselves to God by any human efforts (Eph. 2:1, Rom. 3:9-18).
- We believe that salvation is by God’s grace and action alone (Eph. 2:8-9) accomplished through His Son, Jesus Christ (Jn. 3:16, Acts 4:12, Gal. 4:4-5).
- We believe that Jesus Christ is the eternal Son of God, who became man, lived the perfect life that God requires, died a substitutionary death, and rose again from the dead to atone for the sins of the whole world (Col. 2:9, Acts 2:23-24, 1 Pet. 3:18).
- We believe that it is by the working of the Holy Spirit through the Means of Grace that people receive faith in Jesus as their Lord and Savior (1 Cor. 12:3). The Holy Spirit gives believers the wisdom and strength to walk according to His will (Phil. 2:13, Gal. 5:16-25, Is. 41:10).
- We believe that Jesus shall return visibly and bodily to judge all people. Those who believe in Jesus will live with Him forever, while unbelievers will be condemned to an eternity in hell (Mk. 13:26, Jn. 5:27-29).
Rights and Satisfaction
If you consider that the services you received are unsatisfactory or think your rights have been violated, you have the right to use a grievance procedure. Please contact any Christian Family Solutions counseling office for an information packet on the procedures to follow. Or you may contact the Clients Rights Specialist to request the packet: Christian Family Solutions, Attn: Clients Rights Specialist, W175 N11120 Stonewood Drive, Germantown, WI 53022.
Acknowledgment
Your physical or electronic signature indicates the following:
- You have received this Informed Consent for Counseling Services document and agree to abide by its stated terms. You acknowledge that you are receiving initial counseling services available at no cost through your organization's Member Assistance Program, Employee Assistance Program, or Faculty and Staff Assistance Program;
- You are aware that counseling services available through these plans are intended to be short-term and non-clinical. The intention is to help assess your situation, provide short-term problem resolution, refer to longer-term support if needed, and follow up on your approaches to change;
- You consent to enable us to use and disclose your personal health information for purposes of health care operations;
- You are aware that the Privacy Practice Notice is found here on our website and available in writing at your request;
- You have read and understand the information provided in this document regarding video-assisted counseling services available to you;
- You are aware of your rights and the grievance procedure available to you on our website and in written form;
- You have received information describing the Mission Statement and Statement of Faith from Christian Family Solutions;
- By supplying your home phone number, mobile phone number, e-mail address, and any other personal contact information, you authorize Christian Family Solutions to employ a third-party automated outreach & messaging system to use your personal information, the name of your counselor, the time and place of your scheduled appointment(s), and other limited information, for the purpose of notifying you of a pending or missed appointment.
The time period for this informed consent shall be one year. At the end of this time frame, this material will be shared with you again and your informed consent obtained. You have the right to withdraw informed consent at any time, in writing. This will, in effect, terminate counseling services.