About the Counseling Center

Federal and state regulations require that we explain your privacy rights and how we maintain the confidentiality of your information. All aspects of your participation in counseling at the Counseling Center, including the scheduling of appointments, content of counseling sessions, all contents of counseling records, and outcomes of counseling, are confidential as required by federal and state law. The Counseling Center maintains a confidential record of your counseling services and you have access to your own file only. If you are participating in couples/relationship counseling or group counseling, a separate record is kept for each individual, and all confidentiality policies apply independently to each record. Each person has access to their own file and records only.

Counseling records consist of an electronic file and database components. All parts of your record are highly secured and are protected by the same confidentiality and privacy laws. Clinicians within the Counseling Center may share your personal health information with each other. In addition, in order to provide the most effective and comprehensive services, Counseling Center clinical staff may consult with the providers in the Student Health Center when the student has been or will be referred from one center to the other.

Only professional counseling staff may access clinical progress notes, test data, or other clinical information in your file. Support staff only have access to contact and demographic information and diagnostic codes for the purpose of statistical tracking and reports. No record of counseling is made on an academic transcript. The Counseling Center retains ownership of all physical records and is responsible for establishing policies regarding the retention of counseling records. At this time, we retain counseling records for 7 years after service is terminated. We do not release your information to anyone without your written permission, except when required and allowed by law. Exchange or release of any document(s) contained in your counseling record to the Student Health Center will require you to submit a Release of Information request. Please contact the Counseling Center at 512-245-2208 for further assistance.

Exceptions to Confidentiality

• Texas law requires that clinicians who learn of or have strong suspicions of child abuse or neglect report this information to Department of Family and Protective Services or law enforcement personnel. This pertains specifically to knowledge of abuse or neglect of a client who is younger than 18 years of age; any child younger than 18 years of age suspected of being at risk of abuse or neglect;  or abuse or neglect by a client toward a person who is younger than 18 years of age.
• Texas law requires abuse or neglect of elderly or disabled persons to be reported to the proper authorities.
• If a clinician assesses that you pose an imminent danger to yourself or others, the clinician may do what is necessary to protect life within the limits of the law. Appropriate university officials and staff (e.g. University Police, Vice President for Student Success, Housing and Residential Life staff, etc.) who bear responsibility or may incur liability for the welfare of Texas State students may be notified about the student's situation. Only university officials and staff who have a "need to know" to protect the safety of students will receive this information.
• A legal subpoena can require the release of records kept at the Counseling Center or require a clinician to give testimony at a court hearing.
• Texas law requires a clinician to report client abuse or sexual exploitation by a previous therapist to the appropriate county district attorney and licensing board. Client anonymity will be preserved if requested.
• Nonidentifiable demographics and statistical client data may be used for research studies and institutional reports.

Email

Confidentiality is essential to the counseling process and cannot be assured with email.

We cannot guarantee that the contents of an email message will remain confidential. While we will do our best to keep your communication private, email usage can be monitored and the content of your personal messages may be read by others. Staff access to email is limited to the Counseling Center business hours. Also, you have no way of knowing if a specific staff member is unavailable due to illness, vacation, or other reasons. This means that your message may not be read immediately. If time is of particular concern for you, please consider calling our office when requesting information.

Email is not an appropriate medium for individual questions regarding personal or career counseling. It is most appropriate for requesting general information regarding services, resources, or other campus information. Our staff does not respond to inquiries from our clients regarding specific counseling issues.

TEXAS STATE COUNSELING CENTER

Texas State University, LBJSC 5-4.1, 601 University Drive, San Marcos, TX 78666

Phone 512-245-2208 ∙ Fax 512-245-2234 ∙www.counseling.txst.edu

CONSENT FOR COUNSELING OF A MINOR

If you are a student under the age of 18, you may consent to mental health treatment in accordance with Texas Family Code Section 32.003 if one of the following applies to you:

(Initial all that apply)

    ____ I am now or have previously been married.

    ____ A court order has been entered legally removing the disabilities of my minority.

    ____ I am on active duty with the armed services of the United States of America.

    ____ I am 16 years of age or older and I reside separate and apart from my parents/managing   conservator/guardian and manage my own financial affairs.

    ____ I am seeking counseling for suicidal thoughts; substance abuse or dependency; or sexual, physical, or emotional abuse.

If none of these sections apply to you, a parent/guardian will need to provide consent by filling out the bottom of this form and submitting it to the Counseling Center prior to your first counseling appointment. 

I___________________(student) am requesting counseling from the Texas State University Counseling Center and understand that my parents/legal guardians have access to my Counseling/Mental Health Records and may speak with the Counseling Center about my mental health treatment.  By signing below, I certify that the information I have provided is accurate and that I have read and understand the content of this document, including the limits of confidentiality stated above.

_____________________________________                     ______________________         _____________________

Signature                                                                                             Student ID                                           Date

PARENT OR GUARDIAN

I___________________(parent/guardian) provide consent for ___________________(student) to receive counseling at the Texas State Counseling Center.  By signing this form, I certify that:

I have read and understood the contents of this document

I understand that I have access to Counseling/Mental Health Records and may speak with the Counseling Center about my student’s mental health treatment, if desired

I understand that the content of counseling sessions is confidential and have read and understand exceptions to confidentiality outlined on the Counseling Center website at https://www.counseling.txst.edu/services/counsel/confidentiality.html

I have read the Counseling Center’s Scope of Practice found at

https://www.counseling.txst.edu/about/scope-of-practice.html and understand that treatment may include referrals to other mental health or medical providers, as deemed necessary by Counseling Center staff

________________________________________________          ___________________________________

Parent/Guardian Signature                                                                          Date

Texas State University

Counseling Center

Group Supervision Disclosure Statement

The Texas State University Counseling Center is a training site for masters and doctoral graduate trainees as well as postdoctoral level clinicians.  Doctoral level clinicians are enrolled in the Counseling Center’s doctoral internship in health service psychology which is accredited by the American Psychological Association.

Your group leader is a trainee and is being supervised by a licensed clinician.  During your first meeting with the group leader, the name and contact information of the supervisor will be provided.  Your group leader’s supervisor has full responsibility for the work of the trainee.  Your group leader will meet with their supervisor on a regular basis to discuss the details of their work in group.  Confidentiality, and the limits thereof, apply to both group leaders and supervisors.

If you have any questions about this supervisory relationship, we encourage you to speak to your group leader(s).  Questions may also be directed to the Director of Training, Dr. Clare Duffy, at 512-245-2208.

Signing this form acknowledges your informed consent for treatment by a clinician under supervision. This form will become part of your clinical record.

Enter your TXST ID number (A0…):______________________________

Printed first and last name:  _____________________________________________________

Signature ________________________________   Date Authorized _____________________

Informed Consent for Hybrid Treatment 7.21

Please initial each statement below to indicate that you have read, understand, and consent to treatment.

I have been provided access to and have read the Texas State Counseling Center’s Scope of Practice and Important Information for Clients documents.

I understand that counseling is a collaborative process between clinician and client, the results of which cannot be guaranteed.  There are many different methods that may be used to support the concerns I hope to address, and I agree to make an active effort to work on these issues both during and between counseling sessions.  I also understand that counseling can have both benefits and risks.  Since counseling often involves discussing unpleasant aspects of life, I may experience uncomfortable feelings such as sadness, guilt, helplessness, and anger.  However, counseling frequently has significant benefits which I may also experience, such as improved relationships, solutions to specific problems, and a reduction in feelings of distress.

_____  Initial your understanding and consent

During my initial appointment, the clinician will recommend the most appropriate sources of support for me.  This may include individual counseling, group counseling, referral support, on-line, other university and/or community resources.  The Counseling Center utilizes a brief individual counseling model (detailed in the Scope of Practice).  Appointments are typically scheduled every 2 to 3 weeks.  The estimated number of sessions and frequency will be discussed with my assigned clinician.  Group counseling offers weekly support and skills development and can be utilized each semester of enrollment as assessed to be appropriate upon consultation with the group facilitator(s).  Our referral specialist can assist students in identifying sources of weekly, long-term, intensive, or specialized therapeutic support in the community.  The Counseling Center also offers an easy-to-access, online program called Therapy Assistance Online (TAO) that helps students develop skills and coping strategies. 

_____  Initial your understanding and consent

I understand that the Counseling Center operates as an agency made up of many clinicians and that I am a client of the agency.  A progress note will be created about each individual and group counseling contact and clinicians within the Counseling Center have access to my Counseling Center record.  My clinician will be assigned/reassigned by the Counseling Center based on best match and availability.  In addition, to provide the most effective and comprehensive services, the Counseling Center clinical staff may consult with health care providers in the Student Health Center when I have been or will be referred from one center to the other.  My written consent is required for the Counseling Center to share a portion of my record with the Student Health Center.

_____  Initial your understanding and consent

I understand that all aspects of my participation in counseling at the Counseling Center are confidential as required by federal and state law.  I have been informed there are exceptions to confidentiality which may require my clinician or the Counseling Center to disclose confidential information without my permission (e.g., to report suspected child, elder, or mental health provider abuse; to obtain assistance from medical or law enforcement personnel if I am judged to be a danger to myself or others; in response to a subpoena or court order; and other circumstances as required or allowed by law).

_____  Initial your understanding and consent

I understand that if I have any concerns about services I receive from the Counseling Center I can discuss them with my clinician.  If needed, I can further address my concern with the Counseling Center Director.  If either cannot satisfactorily address my concern, I may submit the complaint to the Assistant Vice President for Student Affairs.  If no satisfactory solution is reached at the Asst. VP level, I may submit a complaint to the appropriate licensing board.  Information pertaining to your clinician’s professional license and how to contact applicable licensing boards can be found on the Counseling Center’s website at https://www.counseling.txst.edu/about-the-counseling-center/counseling-center-staff.html.

_____  Initial your understanding and consent

Hybrid Services (In-Person and Telemental Health)

The Counseling Center provides enrolled students that reside in Texas the opportunity to participate in services via two modalities, in-person or by Telemental Health (TMH).  TMH refers to counseling sessions that occur via phone or confidential video platform.  For students residing outside of Texas, the Counseling Center can provide only brief consultation and support planning due to state licensing requirements.  I understand I am providing consent for both modalities; the clinician(s) at the Counseling Center will provide modality options that best fit my needs, and the modality may change during the course of my counseling.  Each modality has different requirements that will be outlined further in the following sections.

_____  Initial your understanding and consent

In-Person Services

When I engage in in-person services at any point, I understand and acknowledge the following points during a public health crisis (like COVID-19):

• The Counseling Center is taking steps to reduce the risk of spreading viruses (including COVID-19) within the office and has posted these efforts on the website and in the office.  I can ask Counseling Center staff questions about these efforts or about receiving in-person services at any point.
• I understand and agree that by coming to the Counseling Center, I am assuming the risk of exposure to viruses (such as COVID-19, the flu, or other public health risks). This risk may increase if I travel to the Counseling Center by public/shared transportation.
• My clinician can choose to wear a mask for their health and wellness.  I have the option of wearing a mask as well and may be strongly encouraged to wear a mask if a public health incident is underway.
• To protect the health and wellness of the Counseling Center staff and other students, I agree to call the office to cancel my appointment or request to proceed using TMH, if I or someone in my social, living, learning, work, or other close environment has symptoms of or tests positive for COVID-19 OR I have two (2) or more of these symptoms:
• A fever of 100 Fahrenheit or more, chills, or sweating;
• Shortness of breath, difficulty breathing, or new or worsening cough;
• Sore throat, or new loss of taste or smell;
• Muscle or body aches, headache, or fatigue;
• Congestion or runny nose; or
• Nausea, vomiting, or diarrhea.

Cancellations due to these symptoms will not be counted towards the attendance policy. 

• I understand and agree that if the Counseling Center staff has reason to believe I am exhibiting such symptoms, I will be required to leave the office immediately and the Counseling Center staff may follow up with me via phone to check in with me.  I understand and acknowledge I may use Student Health Center services for medical screening and care. 
• I understand and acknowledge that should a Counseling Center staff member test positive for COVID-19, I will be notified in order to take appropriate precautions. 
• I understand and agree that should circumstances warrant, my assigned clinician may make a recommendation to proceed using TMH.  If TMH is not my preferred method of treatment, I understand and agree that I will be provided with community referrals.

_____  Initial your understanding and consent

When receiving in-person services I understand and agree I will:

• Enter the Counseling Center no more than ten (10) minutes before my scheduled appointment time. 
• Adhere to the safe distancing precautions (both visual and verbal) set up in the Waiting and counseling rooms.
• I also understand and agree that the Counseling Center may change precautions based on university, local, state, or federal orders or guidelines and that the Counseling Center will communicate any necessary changes.  If there is a resurgence of the pandemic or if other health concerns arise, counseling services may be only provided through TMH. The Counseling Center will discuss any concerns and will provide community referrals as needed. 

_____  Initial your understanding and consent 

If I receive in-person services I understand and expressly consent to public health contract tracing notifications if I or others in the Counseling Center suite with whom I have had close contact test positive for COVID-19 or any other infection where the Counseling Center is required to notify local health authorities of such exposures. If this report is required, the Counseling Center will only provide the minimum information necessary for data collection and will not provide information about the reason(s) for my visit(s), unless otherwise required by law.  I agree to such disclosure without any additional signed release.

_____  Initial your understanding and consent

Telemental Health Services (TMH)

If I engage in TMH at any point, I understand the following points:     

• Similar to in-person counseling, the results of TMH cannot be guaranteed or assured.
• I am not required to use TMH and have the right to request other service options or withdraw this consent at any time.
• I can ask my assigned clinician or any Counseling Center staff questions about TMH at any point. 
• TMH services may not be appropriate or the best choice of service.  My clinician may determine TMH is not an appropriate treatment option and discuss alternative treatment options if at any time my condition changes or TMH presents barriers to treatment.
• I understand the Counseling Center uses Zoom Telehealth or an application via Therapy Assistance Online (TAO) and all video conferencing platforms are HIPPA compliant. 
• TMH services are conducted and documented in a confidential manner according to applicable laws in similar ways as in-person services. However, I understand there are additional risks including:
• Sessions could be disrupted, delayed, or communications distorted due to technical failures.
• TMH may reduce visual and auditory cues and increase the likelihood of misunderstanding one another.
• In very rare cases, security protocols could fail, and my confidential information could be accessed by unauthorized persons.

_____  Initial your understanding and consent

I understand and acknowledge the following TMH requirements:

• Based on my clinician’s licensure requirements I must only engage in TMH sessions when I am physically in Texas. I understand my clinician will confirm my location at each session.
• My clinician and I will engage in sessions only from a private location where I will not be overheard or interrupted.
• My clinician and I agree to only use a device and/or wi-fi connection that is not accessible to the public and ensure that the device has updated operating and anti-virus software.
• My clinician and I will not record any sessions.  In the case of clinicians who are under supervision, a separate informed consent related to recording and supervision will be provided.

_____  Initial your understanding and consent

Consistent with national standards in TMH, to engage in TMH I must provide contact information for an emergency contact IN MY LOCATION during sessions.  During treatment, the Counseling Center can contact my emergency contact if I am in crisis and my clinician is unable to reach me, or in the case of emergency during a session:

Emergency Contact’s Name:

Relationship to Student:

Emergency Contact’s Address:

Emergency Contact’s City/State/Zip:

Emergency Contact’s phone number:

Contacting the Counseling Center

Please make sure the Counseling Center has a current phone number at which you can be reached.  If you need to reach your clinician between sessions, you may call the Counseling Center at 512-245-2208 during normal business hours (M-F, 8am-5pm, except during university holidays).

If you choose to email your clinician, you acknowledge that email:

• Is not a secure form of communication,
• Should only contain appointment-related communication, and
• Is not continuously monitored, so you will not get an immediate response.

Your clinician will not send private information over email.

_____  Initial your understanding and consent

If I am in crisis outside of normal hours, I agree to do one of the following:

• Call 911 or go to my nearest emergency room in case of a medical or mental health life threatening emergency
• Call the Counseling Center and choose the option to be connected to a mental health provider for crisis assessment and planning
• Call my local county suicide prevention hotline and indicate I am a Texas State student (San Marcos, Avail Crisis Hotline: 1-877-466-0660 or Round Rock, Bluebonnet Trails Crisis Hotline: 1-800-841-1255)
• Call the National Suicide Prevention Lifeline (1-800-273-8255)
• Use a Crisis Text Line- Text HOME to 741741 
• Contact the local mental health authority in county of my location (https://hhs.texas.gov/services/mental-health-substance-use/mental-health-crisis-services)

_____  Initial your understanding and consent

I have read and I understand my rights and responsibilities as I enter into a counseling relationship at the Texas State University Counseling Center.  I agree to show up for (or appropriately cancel) scheduled appointments, to consider medical/psychiatric consultation if recommended, and to follow a crisis safety plan as needed.  If I am assessed to be in crisis, the Counseling Center may contact any persons who can help facilitate my care (e.g., other professionals, my emergency contact, family or friends identified as support resources, referral sources, etc.).  If I have any questions about my rights, responsibilities, privacy, and/or the operations of the Counseling Center, I may ask my assigned clinician or another clinical staff member.

_____  Initial your understanding and consent

Summary Acknowledgements and Informed Consent: 

• I have read, acknowledge, and understand the information provided herein and am aware I can ask Counseling Center staff additional questions, at any time.
• I have received and acknowledge the information provided in the Scope of Practice and Important Information for Clients.
• I am aware of the risks associated with in-person services, agree to follow all Counseling Center safety practices policies, and provide my informed consent for in-person services.
• I provide my informed consent to use Telemental Health when my clinician and I agree it is a beneficial modality.
• I understand and agree that my clinician may determine in-person and/or TMH are not appropriate treatment options and that I may be provided alternative treatment options or referrals at any time.

_____  Initial your understanding and consent

Enter your TXST ID number (A0…):  ________________________

Attendance Agreement- Rev 8.21

Please initial each statement below to indicate you have read, understand, and consent to this Agreement.

Due to the heavy demand for individual counseling and out of respect and fairness to other students who wish to receive services from the Counseling Center, you must call 512-245-2208 to cancel or reschedule your appointment at least 1 day (24 hours) in advance of your scheduled appointment time. 

_____  Initial your understanding and consent

Missing appointments negatively impacts access to Counseling Center services for all students.  The following are criteria that constitute a “no show”:

• Missing your scheduled appointment
• Failing to call and cancel at least 2 hours prior to your appointment
• Arriving 20 minutes or more after your appointment time. 

_____  Initial your understanding and consent

If you no show 2 appointments in the same semester, we are unable to keep any scheduled appointments or schedule another appointment for the remainder of the semester.  You may request referral information.  You may be eligible for counseling services the next semester in which you are enrolled.

_____ Initial your consent

Email reminders are available to help you to remember your appointment.  If you are having difficulty remembering or attending your appointments, please talk to your clinician.  They can work with you to try to address the concern.

_____ Initial your consent

I acknowledge I have read this Agreement and will abide by the conditions set forth in the Agreement.

Enter your TXST ID number (A0…):  ________________________

Communications Agreement- 8.21

To facilitate your counseling experience, you are required to provide the Counseling Center with consent to reach you via ONE form of communication (phone, email, or text). 

_____  Initial your understanding and consent

Phone and Voice Mail

Clinicians will identify their name and that they are calling from Texas State.  If they reach you they will clarify the purpose of their call.  If they leave a voice mail message, they will request you call 512-245-2208 but will not identify themselves as being part of the Counseling Center. 

To opt-out of phone calls at any time, call the Counseling Center at 512-245-2208 to update your file.

_____  Initial your understanding and consent

E-mail

E-mail is not a secure form of communication and Counseling Center staff will not provide personal or counseling related information in e-mail.  E-mails will come from either a general center mailbox or your clinician’s TXST email.  Staff will limit their use of e-mail communication to the following purposes:

•             To provide you with information about your appointment

•             To notify you of appointments not attended or canceled late that impact your access to therapy based on our Attendance Agreement

•             If we are unable to reach you by phone and need you to call the center

•             To acknowledge your e-mail message

•             To provide resources with your verbal consent

Appointment reminders will be sent to your Texas State e-mail address (which you can automatically forward to another preferred e-mail address, if desired). 

To opt-out of e-mail messages at any time, call the Counseling Center at 512-245-2208 to update your file.

_____  Initial your understanding and consent

Text Messages

The Counseling Center can send text messages to:

• Remind you of upcoming appointments
• Request you call the Counseling Center for assistance
• Inform you that you are missing your appointment 

Because text messages are not a secure form of communication, personal or clinical information will not be included in any text communication and the Counseling Center will not be able to receive text messages or replies.  Text message reminders will come from 512-598-6410.

Depending on your mobile plan, texts from the Counseling Center may incur a charge on your monthly bill.  Some cellular phone bills may also include a list of phone numbers from which you received text messages.

To opt-out of text messages at any time, call the Counseling Center at 512-245-2208 to update your file.

_____  Initial your understanding and consent

My TXST ID and Date of Birth below indicate I have read, understand, and consent to the above.

Enter your TXST ID number (A0…):  ________________________

Authorization to Exchange Confidential Information Between the

Counseling Center and Student Health Center

Instructions: In order for the Counseling Center and Student Health Center to exchange confidential information, this authorization must be completed according to these instructions.  All information must be clearly legible.  All information related to identification, location, and communication of those involved in the release of information must be provided.  This is necessary to ensure that the information is released only to those you intend.  For your protection, if this form is incomplete or is not legible, the Counseling Center will not release any information. 

DISCLOSURE WITHOUT AUTHORIZATION IS PROHIBITED BY LAW (Texas Health and Safety Code, Sec. 611.00(4)4)

AUTHORIZE my therapist, ____________________________, and/or the administrative or clinical staff at the Texas State University Counseling Center, LBJSC 5-4.1, 601 University Drive, San Marcos, TX  78666, (512) 245-2208 to exchange with the:

Student Health Center  Texas State University, 298 Student Center Drive, San Marcos, TX 78666 Phone (512) 245-2161

(Initial)     _____Relevant portions of the clinical/medical record                       

The purpose for releasing this information is for collaboration and continuity of care.

This authorization permits the release of documentation of services provided by the Counseling Center.  I hereby release the above parties from any legal liability resulting from the authorized release of information.

____________________________________________________________________________________________________

                Signature of Client                               Date of Birth                                 Date Authorized

• Professionals I can ask for help:

1. Counseling Center: LBJ Student Center 5th floor or 512-245-2208, select option 2 if after-hours
2. 911 or go to local ER: Christus Santa Rosa- 1301 Wonder World Drive, San Marcos / St. David’s- 2400 Round Rock Ave., Round Rock
3. Local 24/7 Crisis Hotline: 1-877-466-0660
4. National Suicide Hotline: 988 or 1-800-273-8255
5. National Crisis Text Line: text HOME to 741741
6. Other:                                                                                

• Follow-up Plan:

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Self-Care Plan

Healthy Activities (exercise, sleep, meditation, hobbies)…

1)                                                                                            3)

2)                                                                                            4)           

Activities to Avoid (drug/alcohol use; certain people; staying awake all night)…

1)                                                                                            3)

2)                                                                                            4)           

Positive Coping Thoughts (it’s ok to feel this way; it’s not a catastrophe, this will pass)…

Ways I can reach out for support (friends, family, groups, clubs)…

People who are supportive

1)                                                                                            2)                                                                            3)

Positive environments (park, coffee shop, campus spot)…

1)                                                                                            2)                                                                            3)

Next steps I can take (specific behaviors to implement now to improve self-care)…

1)                                                                                            5)

2)                                                                                            6)            Use TAO https://us.taoconnect.org/login

3)                                                                                            7)            Watch Bobcat Mental Wellness Videos

4)                                                                                            8)            Use Phone Apps

These steps will help me work towards my goal(s) of

Next Counseling Appointment:

The Texas State University Counseling Center is a training site for masters, doctoral, and postdoctoral level clinicians.  Doctoral level clinicians are enrolled in the Counseling Center’s doctoral internship in health service psychology which is accredited by the American Psychological Association.

With your consent, your clinician will be supervised by a licensed psychologist and your sessions may be recorded for supervision purposes. If your clinician is a practicum clinician, they may be supervised by a psychology intern, who is in turn supervised by a licensed psychologist.  If your clinician is a postdoctoral resident, they are supervised but typically do not record sessions.  Additional consent from you would be obtained if they need to record. 

During your first session with your clinician, the name and contact information of the supervisor will be provided. Your clinician's supervisor has full responsibility for the work of your clinician and will meet on a regular basis to discuss the details and progress of their work with you.. Confidentiality, and the limits thereof, apply to both clinicians and supervisors.

If you have any questions about this supervisory relationship, we encourage you to speak to your clinician.  Questions may also be directed to the Director of Training, Dr. Clare Duffy.

Signing this form acknowledges your informed consent for treatment by a clinician under supervision and your consent to have your sessions recorded for supervision purposes, if necessary.  This consent supersedes the general informed consent regarding recording sessions. This form will become part of your clinical record.  The audio, video, or digital recording of any session, however, is not part of your clinical record and will be deleted when it is no longer needed for supervision purposes.

My TXST ID and Date of Birth below indicate I have read, understand, and consent to the above.

If you do not consent, please exit this form and inform your therapist.  They will reassign you to an appropriate clinician.

Telemental Health (TMH) services are currently being offered via phone or HIPAA-compliant Zoom video.  Clients who prefer TMH and do not have access to a private space and/or a computer with camera and microphone should speak with their clinician about what options may be available. 

Please refer to the following pros and cons of TMH to help you make informed decisions about your care. 

PROS

• TMH through phone or HIPAA-compliant Zoom video prevents possible exposure to illnesses
• You can engage in TMH in a private space that is comfortable to you (e.g., bedroom, home office, or stationary car).
• There is no need to travel to campus or the LBJ Student Center.
• Scheduling may be easier since you do not have to plan for commute time.
• Evidence is accumulating to suggest that the degree of clinical effectiveness of TMH treatments is comparable with the same treatments delivered in conventional in-office settings (Pruitt, Luxton, & Shore, 2014).

CONS

• Depending on your living situation it may be difficult to find a private space for sessions. There may be distracting factors in your home (e.g., pets, noise from roommates or family) that you may need to address. Clinicians can help you brainstorm other private options such as sitting in a stationary vehicle, using a private room on campus, or being in a private outdoor area.
• Technology is not always reliable and there can be interruptions in your session. If there is an interruption, your clinician will call you.
• You may not always have consistent access to a phone, computer, or internet with reliable bandwidth. 
• Sometimes clients find it difficult to feels as “connected” during TMH sessions as they do during in-person sessions. You are welcome to discuss this with the clinician to find opportunities to improve the connection.