Counseling Services

CONSENT TO TREATMENT - Telemental Health Services

University Counseling Services primarily offers traditional in-person, face-to-face counseling sessions. However, telemental health services may be offered from March 16 through the end of spring semester, due to the suspension of classes, transition to online learning, and possible campus closure as a response to the presence of coronavirus. Your counselor will determine when it is deemed appropriate and necessary to offer services through telehealth rather than face to face. This document is an addendum to our “Consent to Treatment” and “Electronic Communication Consent” forms.

In California, “telehealth” is defined as a method to deliver health care services using information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient and provider are at two different sites.

Information About Telemental Health Services

• You have the right to withhold or withdraw your consent for telemental health services at any time without affecting your right for future care or treatment; nor risking the loss or withdrawal of any other service benefits to which you would otherwise be entitled.

• Telemental health services are not appropriate if you are experiencing a crisis or having suicidal or homicidal thoughts.

• If a life-threatening crisis should occur, you must agree to contact your local suicide prevention hotline or the National Suicide Prevention Lifeline at 1-800-273-8255, call 911, or go to your nearest hospital emergency department.

• UCS counselors follow the laws and regulations of the State of California Board of Behavioral Services. Therefore, counseling and telemental health services can only take place in the State of California. Both the counselor and client must be physically in the State of California to engage in telemental health.

• You must inform your counselor of the location in which you will consistently be during your sessions and inform them of any location changes.

• If your counselor believes you would be better served by face-to-face services that cannot be provided by UCS, you will be referred to a counselor or resource who can provide such services in your area.

• When receiving telemental health services, you must be in a private location where you will not be overheard or interrupted. UCS will not be responsible for any breaches of confidentiality that occur due to your selected location or information heard by others who may be in the vicinity.

• You agree to not record any telemental health session with any device.

• Despite reasonable efforts on the part of your counselor, there are risks and consequences from telemental health services, including, but not limited to, the possibility that transmission of your services could be disrupted or distorted by technical failures, or be interrupted by unauthorized persons. In addition, it is possible that a third party may be able to intercept and eavesdrop on those messages.

• If your counselor is uncertain of your safety or the safety of others and is unable to reach you, your counselor may contact someone from the CARE team at Dominican or your local emergency agency.