Section 4: The Statement of Understanding for Collateral Contact/Adjunct Parties to Treatment

When clients ask for or allow adjunct parties to attend one or more sessions to provide support and/or background information, and those adjunct parties do not become clients themselves by entering into a treatment relationship, then those parties are not accorded certain rights and privileges that are typically accorded to clients. Most importantly, a person who does not enter into or intend to enter into a treatment relationship will generally not acquire the right to privileged communication. This means that what they say in treatment may be subject to release if a clinician receives a subpoena from an attorney, since privilege was not established.

It cannot be assumed that those adjunct parties will know their rights and the limitations to their rights when they come in to support the clinical work of the identified client. For this reason, it is important to have a process for informing the adjunct parties of these matters, and helpful to have a form that records the details of that conversation. This is the purpose of the Statement of Understanding for Collateral Contact/Adjunct Parties to Treatment.

This form is shown below:

 

Statement of Understanding for Collateral Contact/Adjunct Parties to Treatment

Overview

Pat R. Clinician, LCSW provides counseling services in accordance with professional standards of practice. These standards of practice include providing to each person who attends a counseling meeting important information in advance concerning their participation in the counseling process, including their rights and responsibilities as a collateral contact or adjunct party to treatment. Adjunct parties who attend sessions to provide support to clients and/or to provide important background information, but who are not themselves entering into a treatment relationship, do not become clients. Accordingly, their rights and responsibilities are different from those of clients.

Rights Accorded to Collateral Contacts/Adjunct Parties

Each collateral contact or adjunct party to treatment has the right to expect to be treated in an ethical and professional manner in accordance with accepted professional standards. Each collateral contact or adjunct party to treatment has the right to request information about the nature and extent of their role in supporting the treatment of the client(s) for whom they have agreed to serve as a collateral contact or adjunct party, including clear information about limits to that role and responsibilities within that role.

Rights Not Accorded to Collateral Contacts/Adjunct Parties

Because collateral contacts/adjunct parties to treatment do not become clients, they are not accorded the right to privileged communication. This means that your communications in the collateral sessions are not protected under the laws and statutes that govern the right to privileged communication accorded to clients who have entered into a treatment relationship. As a collateral contact or adjunct party to treatment, you also do not have the right to receive any information about the client(s)’ counseling treatment except to the extent that the client(s) give permission to provide this to you and sign a release of information that clarifies specifically what information may be released to you.

Fees and Insurance

The fee for the session(s) you attend will be charged at a rate that has been determined in prior discussions with the client for whom you have agreed to serve as a collateral contact/adjunct party to treatment. If it is determined appropriate to file insurance for the meeting(s) you attend, the insurance claim will be filed under the name of the client, and your name or other identifying information will not be submitted along with the claim. However, should the insurance company request to audit the chart, your personal information must be made available to them. Because you are not entering into a treatment relationship, no claim may be filed under your name.

Referrals for Additional Services

In the course of our meetings, if it should be determined that you would benefit from your own counseling treatment, an appropriate referral will be made.

Statement of Validation

 

I have read this Statement of Understanding, it has been adequately explained to me, and I understand its contents.

 

By Collateral Party(s)                                               

Print Name Here                      Sign Here                  Date

____________________          ________________            _____________                                                

Print Name Here                      Sign Here                  Date

____________________          ________________            _____________

 

By Pat R. Clinician, LCSW

Print Name Here                      Sign Here                  Date

____________________          ________________            _____________

 

 

 

 

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