This Services Agreement (the “Agreement”) is entered into by Shatter Silence Inc. (“we/ us/ our”, which includes your Counselor), and you, the Client, and by using our website or Services, you have agreed to this Agreement. So please do not use our Website or Services if you disagree with this Agreement or if you do not understand this Agreement. Any other disclaimers on our website are a part of this Agreement. We may modify or change this Agreement without notice to you, and any changes or modifications are effective immediately when published.
One of our Life & Grief Counselors (individually the “Counselor”) will provide Peer to Peer confidential conversations, positive psychology education, ASIST Training for Trainers, Question Persuade Refer (QPR), SOS, and other suicide, depression, and grief services (our “Services”) to address the issues you have identified on your Intake Form. You are agreeing only to the Services that the Counselor is qualified to provide within the scope of their training. Our Counselors are not licensed therapists, psychiatrists, or doctors. Through our Services, you may realize benefits such as better coping with suicidal thoughts or depression or insight into personal and professional goals. However, you may face risks involved as well, such as negative emotions or discomfort in your relationships. Further, while we strive to help you find resolution to the concerns brought to us, you understand we cannot guarantee resolution. We may recommend additional sessions and/or Services and/or referrals, but it ultimately depends on your investment into our Services and yourself. Ultimately, we cannot be held responsible or liable for your actions; only you can take that responsibility. You agree to defend, indemnify, and hold us harmless for claims or damages (including any legal fees) that result because of your actions.
All other services outside the Scope of Work will not be included in this Agreement, unless both you and we agree, which email will suffice. Nothing in this Agreement or our statements to you will be construed as a warranty, promise, or guarantee about the outcome of our Services.
If an emergency situation arises, please call 911 or proceed to any local emergency room.
You agree to pay for our Services based upon the “Payment” section as stated above either before or at the start of each session. We do not accept payment plans or insurance or checks. The standard billing rates is twenty-five dollars per hour ($25/hr). From time to time, our hourly rates may change, but we will notify you if we implement that change. Each session will be charged for at least a one (1) hour minimum and in fifteen (15) minute increments afterwards.
Appointments & Cancellations
Appointments for sessions will be booked on the Website. Please remember to cancel or reschedule 24 hours in advance. You will be responsible for the one-hour session fee if cancellation is less than 24 hours. Further, if you are late to a session, the session time for billing still begins at the scheduled time. Please note that multiple missed/cancelled appointments and/or late arrivals may require us to discontinue counseling. The standard meeting time for consulting is one hour; however, it is up to you to determine the length of time of your sessions. Requests to change the one-hour session needs to be discussed with your Counselor in order for time to be scheduled in advance. In the event that you request additional appointment time beyond the allotted session time, an additional, out of pocket fee will be incurred in 15-minute increments as listed in the Payment section. If we do not hear from you after a missed appointment and have reason for concern, we may reach out to your identiﬁed emergency contact to ensure your well-being.
If your Counselor is running behind, he or she will attempt to communicate this to you. In the case that your Counselor is running behind, as long as your schedule permits, you and your Counselor will still meet for the full session time.
Confidentiality & Communication
(A) Privacy and Confidentiality
Confidentiality means that we have a responsibility to safeguard information obtained during your sessions. All identifying information about your consultation is kept confidential, except as mandated by law. You must sign a release of information before any information about you is given to anyone, except as mandated by law. You may find more details and the release below in Exhibit A “HIPAA: Notice of Privacy Practices for Protected Health Information”.
Although the internet provides the appearance of anonymity and privacy in counseling, privacy is more of an issue online than in person. The Client is responsible for understanding the potential risks of confidentiality being breached through unencrypted email, lack of password protection or leaving information on a public access computer in a library or internet café.
Other potential risks of breaching confidentiality could include messages failing to be received if they are sent to the wrong address or if they are just not noticed by the Counselor. Confidentiality could be breached in transit by hackers or internet service providers or at either end by others with access your account or computer. Clients accessing the internet from public locations such as a library, computer lab, or café should consider the visibility of their screen to people around them. Position yourself to avoid others seeing your screen. Using cell phones can be risky in that signals are scrambled but rarely encrypted.
You are responsible for securing your own computer hardware, internet access points, chat software, email and passwords that are encrypted, secure, and HIPPA compliant when possible. If encryption is not made available to you, you should be aware that they are risking unauthorized monitoring of transmissions and/or records of Internet counseling sessions.
YOU AGREE TO TAKE FULL RESPONSIBILITY FOR THE SECURITY OF ANY COMMUNICATIONS OR SERVICES ON YOUR OWN COMPUTER AND IN YOUR OWN PHYSICAL LOCATION. You understand you are solely responsible for maintaining the strict confidentiality of your user ID and password and not allow another person to use your user ID to access the Services. You also understand that you are responsible for using this technology in a secure and private location so that others cannot hear our conversation.
If we are working together online, we ask that you determine who has access to your computer and electronic information from your location. This would include family members, co-workers, supervisors, and friends and whether or not confidentiality from your work or personal computer may be compromised due to such programs as a keylogger.
We encourage you to only communicate through a computer that you know is safe i.e. where confidentiality can be ensured. Be sure to fully exit all online counseling sessions and emails. If you used location-based services on your mobile phone, you may wish to be aware of the privacy issues related to using these services.
(B) Lack of Non-Verbal Cues and Asynchronous Communication
You should be aware that misunderstandings are possible with telephone, text-based modalities such as email, and real-time internet chat, since non-verbal cues are relatively lacking.
Even with video chat software, misunderstandings may occur since bandwidth is always limited and images lack detail. Counselors are observers of human behavior and gather much information from body language, vocal inflection, eye contact and other non-verbal cues. If you have never engaged in online counseling before, have patience with the process and clarify information if you think your Counselor has not understood you well. Be patient if your Counselor asks periodically for clarification as well.
(C) Potential Risks of Receiving Technology-Assisted Counseling & Safeguards
There are various risks related to providing technology-assisted counseling services related to the technology used, the distance between Counselor and Client, and issues related to timeliness. These risks of concerns for privacy and confidentiality were mentioned in Sections above. You are responsible for creating and using additional safeguards when the computer used to access services may be accessed by others such as creating passwords to use the computer, keeping their Email and chat IDs and passwords secret, and maintaining security of their wireless internet access points (where applicable.) Please discuss any such concerns with your Counselor during your first session so as to develop ways to limit risks.
(D) Alternatives to Technology-Assisted Counseling & Referrals
Online counseling may not be appropriate for many types of Clients including those who have numerous concerns over the risks of internet counseling, Clients with active suicidal/homicidal thoughts, Clients who are experiencing active manic/psychotic symptoms, or Clients who are minors. The Counselor may refer you to a more appropriate person or organization for services.
(E) Possible Technical Issues
You understand that counseling conducted online is technical in nature and that problems may occasionally occur with internet connectivity. Difficulties with hardware, software, equipment, and/or services supplied by a third party may result in service interruptions. Any problems with internet availability or connectivity are outside the control of the Counselor and the Counselor makes no guarantee that such services will be available or work as expected. If something occurs to prevent or disrupt any scheduled appointment due to technical complications and the session cannot be completed via online video conferencing, you agree to call your Counselor back at: 1-800-273-8255.
(F) Recording of Sessions
You understand that there will be no recording of any of the online session and that all information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission, except where disclosure is required by law.
(G) Social Media
We maintain multiple social media accounts for our company. These accounts serve to promote our services and offer encouragement and resources. They are not a substitute for counseling or our Services and nothing shared should be interpreted as a personal message. We do not interact with clients via social media. We also do not expect you to follow any of the accounts based on our work together. If you choose to follow one of the accounts and do reach out to us, or a Counselor, via that method, we will discuss that further in our next session. We may remove your communication/comment/message from our account if we feel it violates your conﬁdentiality. Due to the importance of your conﬁdentiality and the importance of minimizing dual relationships, neither we nor our Counselors may accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc.).
We do not work with individuals under the age of 16. If you are a minor who is 16 or 17, your parents may be legally entitled to some information about your counseling. We will discuss with you and your parents/ guardians what information is appropriate for them to receive and which issues are more appropriately kept conﬁdential. It is important to note that you, the minor, are the client and not your parent or guardian. That means we will respect your privacy and keep information shared in session as conﬁdential. However, if we feel there is an issue that may relate to your safety, we may need to discuss that issue with your parent/guardian. There are also times when it is helpful to involve parents/guardians in various ways. This may include things like updates or discussion before or after our session or joint sessions with them. If we believe involving your parent/guardian would be beneﬁcial, we will discuss this with you. You may have the right to refuse their involvement. In most circumstances, it is not our practice to keep communications from parents/guardians’ secret from my clients. If your parent/guardian raises concerns outside of our meeting together, we will discuss with them the best way to address this with you. We encourage all of us to keep communication as open as possible. We keep notes about your sessions with the Counselor. In some circumstances, you have the right to determine whether or not your parents/ guardians may view these records. If there is a request to release or view any of your records we will discuss this further with yourself and your parent/guardian to determine the appropriate action. Additionally, we are not permitted to make custody recommendations. Therefore, we will not make a recommendation on custody if requested by any party involved in the case.
We may be required to disclosure your information or our communications to help avert a serious threat to the health and safety of others, or for law enforcement purposes, including reporting crimes. We are required to disclosure your disclosure your information or our communications for public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s (including your own) health or safety.
Ending relationships can be difﬁcult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the counseling. We may terminate counseling after appropriate discussion with you and a termination process if we determine that the counseling is not being effectively used or if you are in default on payment. Similarly, we have the right to terminate this Agreement if you:
(A) Do not make a payment
(B) Do not show up for a scheduled session
(C) disrespect, defamation, and be honest (including last minute demands or court proceeding interference)
(D) If additional services are required outside the area of expertise
Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, we must consider the professional relationship discontinued.
Please be advised that should we (which again includes your Counselor) be requested to write a letter on any court related matter, we will NOT be stipulating in writing or in person as to an opinion. Your Counselor may only provide observations and feedback. At no time will we make a recommendation in regard to custody or any other court related matter. If a court order is served and is requesting that we be present in person and/or there is a request for records, we will request your consent before turning over conﬁdential information. We will discuss with you exactly what has been requested by court and there is no guarantee that the information will be kept conﬁdential. This information includes mental health history, current status, and inclusive records and may not be in your best interest. The Counselor-client relationship does not render your Counselor or us as your advocate. We will withhold any opportunity to engage in a dual relationship in this way.
Should we be ordered by court to write a letter to the court, the time shall be billed at $50 per hour. Should we be court ordered to appear in court, the fee stipulation is as follows: $50 per hour, including but not limited to time for travel and preparation. We will not be on-call at any time. Should a case go to trial, we will be paid in full for each day as well as an additional $50 per hour as it hinders our ability to be available to other clients. All court fees must be received fourteen (14) days prior to the court date. Should the court calendar the hearing for another date, we must be re-issued a court order with the new court hearing date. Should we be on vacation, the party initiating the court order must take reasonable steps to avoid imposing undue burden or expense on a person subject to the subpoena.