This consent form explains the nature of the service(s) you are about to receive. As consent is an ongoing process, any changes that may influence your consent will be discussed with you.
Nature of services
We provide walk-in crisis services and appointment-based triage for veterans and their families.
Crisis services are provided with a single-session model. This means that although you may return for future sessions, you may not see the same therapist.
Confidentiality
We keep records which may include items such as personal information, progress notes, and evaluations, and will be shredded/deleted 7 years after your file has been closed. No information about you can be released to a third party without your prior written or verbal consent, except in the case of an emergency. Exceptions include: (1) when children are under 16 years of age, and their parents/legal guardians want access to the file, (2) risk of imminent danger, such as suicide, death, risk of a child running away, or serious bodily harm to an identifiable person or group (including yourself), (3) suspected or known abuse or neglect of a child, disabled person or older adult, (4) requests ordered by a court of law, (5) access is required by other personnel (e.g., administrative staff) to carry out their professional duties, or (6) therapists needing to access your file to provide services (e.g., walk-in treatment). Therapists must, as soon as the interest of their client so requires, receive supervision, consult another therapist, a member of another professional order, or another competent person. Disclosure of identifying information will be minimized, and names will not be released without consent.
We will work closely with other agencies to coordinate the best support for you. This means your informed consent for the sharing of information will be sought and respected in all situations unless:
we are obliged by law to disclose your information regardless of consent or otherwise;
the disclosure is reasonably necessary to prevent or lessen a serious threat to a person's life, health or safety.
Research Participation
You are being asked to be part of a research study. We want to find out about the problems affecting veterans and their families on PEI and about their biopsychosocial needs. By learning about the problems and needs, we hope to design better programs to assist veterans and their families. We would like to invite you to participate.
To obtain this information, we will be using the information gathered from veterans and their families during the intake and at other points in the program, which you will be asked to complete whether or not you are participating in the study. We will use a variety of self-report tests and interviews to gather this information. If you agree to participate in this study, we will use your information to help determine PEI veterans' needs, monitor our program's usefulness, and develop better services.
However, there may be no direct benefit to you personally.
It is your decision whether or not to be in this study. You can stop being in this study at any time. This will not affect any assistance you get from us or any other organization.