Informed Consent

Declaration of Practices and Procedures

Qualifications

I am practicing as a Licensed Professional Counselor – LPC.  Louisiana License #7120 | Texas License #82235

I earned a Master of Arts in counseling psychology from McNeese State University in 2017. The Texas LPC Board of Examiners mailing address is 8407 Wall St, Austin, TX 78754, phone number: (512) 834-6658.

Counseling Relationship

Counseling is a collaborative, professional working relationship where your strengths, areas for growth, problems, and needs, are identified and addressed.  Counseling is most effective when you participate actively in the process by communicating your needs and goals, practicing learned skills outside our sessions, and completing out of session assignments.


My approach to counseling uses evidenced-based strategies best suited to your needs and goals. Examples of the evidenced-based interventions I use typically include Acceptance and Commitment Therapy (ACT), Cognitive-Behavioral Therapy (CBT), Motivational Enhancement Therapy (MET), Play Therapy, and Solution-Focused Brief Treatment (SFBT).

Clients Served/ Services/ Referrals

I have a general counseling practice with specialization in the treatment of anxiety disorders, LGBTQ concerns, adjustment to major life transitions, addiction, depression, grief and loss, relationship issues, and health and wellness. I have specialized training and experience in treating adults with substance use and co-occurring mental health disorders. It is sometimes necessary to refer a client to other professionals, agencies, community programs, or appropriate resources when they will better meet your needs. Ethical practice dictates recognizing issues that are beyond my base of knowledge or skills. I will recommend a referral when it is reasonably clear that a client is not benefiting from the professional relationship. Before any referral, we will discuss my recommendations and potential referral options. You may request to be referred to another professional or agency at any time.

Meetings

I normally conduct an evaluation that will last from 2 to 4 sessions.  During this time, we can both decide if I am the best person to provide the services you need in order to meet your treatment goals.  If we agree to begin counseling, I will usually schedule one 50-minute session (one appointment hour of 50 minutes duration) per week, at a time we agree on, although some sessions may be longer or more frequent.  Once an appointment hour is scheduled, you will be expected to pay for it unless you provide 24 hours advance notice of cancellation [unless we both agree that you were unable to attend due to circumstances beyond your control.  In which case, if it is possible, I will try to find another time to reschedule the appointment.]

Professional Fees

My hourly fee is $125 [unless otherwise negotiated].  If we meet more than the usual time, I will charge accordingly.  In addition to weekly appointments, I charge this same hourly rate for other professional services you may need, though I will prorate the hourly cost if I work for periods of less than one hour.  Other professional services include report writing, telephone conversations lasting longer than 12 minutes, attendance at meetings with other professionals you have authorized, preparation of treatment summaries, and the time spent performing any other service you may request of me.  If you become involved in legal proceedings that require my participation, you will be expected to pay for any professional time I spend on your legal matter, even if the request comes from another party.  [I charge $200 per hour for professional services I am asked or required to perform in relation to your legal matter.  I also charge a copying fee of $10 per page for records requests.]

Billing and Payments

You will be expected to pay for each session at the time it is held, unless we agree otherwise or unless you have insurance coverage that requires another arrangement.  Payment schedules for other professional services will be agreed to when such services are requested.  [In circumstances of unusual financial hardship, I may be willing to negotiate a fee adjustment or payment installment plan.]
If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment.  This may involve hiring a collection agency or going through small claims court.  [If such legal action is necessary, its costs will be included in the claim.]  In most collection situations, the only information I will release regarding a patient’s treatment is his/her name, the dates, times, and nature of services provided, and the amount due. 

Confidentiality of Client Records (for adult clients)

The Health Insurance Portability and Accountability Act (HIPAA) and Federal law (42 CFR Part 2) protects your privacy. In general, I may not confirm or deny that you are a client or disclose any information about you or our sessions without a release of information signed by you.

Exceptions include:
· When you are a danger to yourself or someone else (to protect you, or other parties, from a clear and imminent threat of serious physical harm)
· Suspected cases of child abuse/neglect, abuse/neglect of persons 65 or older, or dependent adult abuse/neglect
· Court order directing the disclosure of information· Medical/psychiatric emergencies
· Research, program audit, or evaluation (e.g., case record review the Program Director, or a contract monitor)

Privileged Communication

Before a mandated disclosure, it is my policy to assert privileged communication on behalf of the client and the right to, if possible, consult with the client, except during an emergency. I will attempt to inform clients of all mandated disclosures, as possible.


When working with couples, families, or groups, I cannot disclose any information outside of the treatment context without a written release of information from all individuals competent to sign such authorization. For example, I cannot release any information about either or both partners I have seen for couples counseling to an attorney, without a signed release of information from both partners.

When working with a couple or family, information shared by individuals in-session where other family members are not present must be held in confidence (except for the mandated exceptions are noted above), unless all individuals involved sign releases of information at the start of counseling. Clients may refuse to sign such authorizations, but are advised that maintaining confidentiality for individual sessions during couples or family counseling could impede or even prevent a positive counseling outcome.                                                                                                                                                                                                                                                                                                               

Contacting Me

I am often not immediately available by telephone.  Though I am usually in my office between 9 AM and 6 PM, I probably will not answer the phone when I am with a patient.  When I am unavailable, my telephone is answered by an answering service [voice mail] that I monitor frequently.  I will make every effort to return your call within 1 business day.  If you are difficult to reach, please inform me of some times when you will be available. If you are unable to reach me and feel that you cannot wait for me to return your call, contact your family physician, the mobile crisis outreach team 512-472-HELP (4357) or the nearest emergency room.  If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact, if necessary.

Telehealth Using Google Meet and/or Minecraft Realms

I understand that Google Meet and Minecraft Realms are HIPAA compliant.  I understand that it is my decision to communicate with Bill Deggs, LPC using Telehealth options such as Google Meet and/or Minecraft Realms in place of or in addition to counseling therapy in a traditional office setting.

Client Responsibilities

Participate actively in the counseling process, communicating your ongoing needs and goals. Notify me of any other ongoing professional mental health relationship. My code of ethics does not permit me to offer professional services to a person already receiving counseling from another professional, except with the knowledge of the other professional. If you are seeing another mental health professional, then they must give permission for me to work with you.

Emergencies

In the event of a medical or psychiatric emergency, immediately contact 911 or go to emergency room nearest you.
Generally, I can be contacted during regular office hours by calling (512) 387-4144. If I am not available to take your call, please leave your name, phone number, and a brief message on the voicemail. Please state the nature of your emergency, so that I may reach you as quickly as possible.

Physical Health

I suggest a complete physical examination if you have not had one within the past year. Please share with me the name of your physician(s)/nurse practitioner(s), as well as information about any allergies, prescribed medications, or medication changes.

Termination

Termination of the counselor-client relationship can occur in different ways. It is important that we prepare for the termination of treatment from the outset. You can choose to end counseling at any time. You have the right to expect that the counseling relationship will end when you have reached maximum benefit from it or have achieved your treatment goals.

Potential Risks

In the course of mental health counseling, you may become aware of new or additional issues that may not have surfaced prior to the onset of the counseling relationship. This may cause temporary distress. Please continue to communicate your ongoing needs and goals. Changes in relationship patterns that may result from couples/family counseling may produce unpredicted and/or possible adverse responses from other people in the client’s social system.

Parent Authorization for Minor's Mental Health Treatment

In order to authorize mental health treatment for your child, you must have either sole or joint legal custody of your child.  If you are separated or divorced from the other parent of your child or if your child has ever been involved in a Child Protective Services (CPS) case, please notify me immediately.  


I will ask you to provide me with a copy of the most recent custody decree that establishes custody rights of you and the other parent or otherwise demonstrates that you have the right to authorize treatment for your child.

If you are separated or divorced from the child’s other parent, please be aware that it is my policy to notify the other parent that I am meeting with your child.  I believe it is important that all parents have the right to know, unless there are truly exceptional circumstances, that their child is receiving mental health evaluation or treatment.


One risk of child therapy involves disagreement among parents and/or disagreement between parents and the therapist regarding the child’s treatment.  If such disagreements occur, I will strive to listen carefully so that I can understand your perspectives and fully explain my perspective.  We can resolve such disagreements or we can agree to disagree, so long as this enables your child’s therapeutic progress.  Ultimately, parents decide whether therapy will continue.  If either parent decides that therapy should end, I will honor that decision, unless there are extraordinary circumstances.  However, in most cases, I will ask that you allow me the option of having a few closing sessions with your child to appropriately end the treatment relationship. 


Although State laws may give parents the right to see any written records I keep about your child’s treatment, by signing this agreement, you are agreeing that your child or teen should have a “zone of privacy” in their meetings with me, and you agree not to request access to your child’s written treatment records.

Parent/Guardian Agreement Not to Use Minor's Therapy Information/Records in Custody Litigation

When a family is in conflict, particularly conflict due to parental separation or divorce, it is very difficult for everyone, particularly for children.  Although my responsibility to your child may require my helping to address conflicts between the child’s parents, my role will be strictly limited to providing treatment to your child.  You agree that in any child custody/visitation proceedings, neither of you will seek to subpoena my records or ask me to testify in court, whether in person or by affidavit, or to provide letters or documentation expressing my opinion about parental fitness or custody/visitation arrangements.  


Please note that your agreement may not prevent a judge from requiring my testimony, even though I will not do so unless legally compelled.  If I am required to testify, I am ethically bound not to give my opinion about either parent’s custody, visitation suitability, or fitness.  If the court appoints a custody evaluator, guardian ad litem, or parenting coordinator, I will provide information as needed, if appropriate releases are signed or a court order is provided, but I will not make any recommendation about the final decision(s).  Furthermore, if I am required to appear as a witness or to otherwise perform work related to any legal matter, the party responsible for my participation agrees to reimburse me at the rate of $200 per hour for time spent traveling, speaking with attorneys, reviewing and preparing documents, testifying, being in attendance, and any other case-related costs.  I require a retainer fee of $1,000 to cover my fees up to a five hour limit. I will bill you for additional hours beyond the five hour limit.

Agreement

I have read the Informed Consent/ Declaration of Practices and Procedures of Bill Deggs, LPC, and my signature below indicates my full informed consent to services including telehealth services provided by Bill Deggs, LPC.

Click Next to Electronically Sign Document

 

Family & Youth Therapy, PLLC

512-387-4144

13110 Hwy 290 Suite 202 Austin, Texas 78737

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