Policy Notice
The Daring Space’s Statement on Active Anti-Racism, Diversity, Equity, & Inclusion
The Daring Space is an actively Anti-Racist Private Therapy Practice. All therapy services and interactions are geared towards constant learning and growing in multicultural competency, diversity, equity, inclusion, and anti-racist practices.
As the owner and psychotherapist in The Daring Space, these areas of service and education are deeply important to me, and my goal is to do my very best to provide an actively inclusive and safe space for all BIPOC clients as well as clients from the LGBTQIA+ community. I am in no way perfect and I will mess up from time to time. This does not make these missteps ok or acceptable, but I want everyone coming into work with me to know that I am eager to learn and actively seeking opportunities to grow myself in these areas.
The therapy setting and relationship is a deeply personal one and it is important to me that I am constantly and curiously seeking to do better, know more, and be more sensitive to those who come to me for support. I want to recognize that it is not the client’s place to educate me about their experiences as a BIPOC or member of the LGBTQIA+ community, but I also want to create a place where each client feels comfortable expressing their boundaries and lived experiences in society without fear of doubt or questioning from me. Hold me accountable when you need to.
For myself, I make a commitment to my people and my ethics to always be training and growing in these hugely important areas of life. Thank you for working with me at The Daring Space!
Helen Jennings-Hood, Ed.S., LPC, TA
Professional Disclosure Statement
Thank you for choosing The Daring Space and for choosing me as your therapist. I have designed this form to assist you in understanding the counseling process, the risks, and benefits of therapy, what is expected from you, and our professional counseling relationship. Please read this document in its entirety and sign and date at the bottom. I will need you to acknowledge and agree to this document by printing, signing, and emailing it back to me. I look forward to working with you!
My Qualifications
I have an Education Specialist’s degree in Counseling and Psychology with a focus on Clinical Mental Health Counseling from Arkansas State University. I am currently licensed by the Arkansas Board of Examiners in Counseling as a Licensed Professional Counselor and I have a telemental health specialization. I am trained in trauma therapy and am a trained Trauma-Focused CBT therapist listed with UAMS. I have continuing education hours in childhood trauma, grief, bereavement and loss, trans-affirming and LGBTQIA+ therapy, multicultural counseling, play therapy, leadership, motivational interviewing, diversity, and inclusion.
How I Practice Therapy:
I belong to the Humanistic view of therapy and consider myself a Person-Centered therapist. I focus on each person holistically This means that I want your inside self to match your outside self so that you can be your best self. This concept is called congruence and it allows you to feel confident as showing up as your genuine self in the world. I believe that each person needs to be accepted as they are, in order to grow into who they will become.
I see therapy as a way for us to examine each part of what bothers you and work towards finding a new and healing way to view it. I may often ask you to turn something around in your mind and look at it a different way. I believe that a therapist is a support and companion on a journey with the people that they work with and that my job is to accept you and help you grow. Often I find that this looks like me summarizing what you tell me in a way that you can find healing and growth within what you already know.
Another belief that I have about therapy is that most of the hardest work happens in between sessions. That means that I need you to come to your sessions ready to work and motivated to change. Holding back and not being open only hurts your progress. This also means that I am a firm believer in affirmation. If you did the work and applied yourself, you should have the praise. Sometimes it can be hard to hear that you have done well and have made changes on your own. Often this will get better with time and practice.
Possible Risks in Therapy:
As with any type of therapy, there may be risks associated with online therapy. Therapy is a private and arduous process at times and can bring up uncomfortable and hard emotions. There may be times when things may not seem to be getting better and, no lie, there may even be times when you think that things are getting worse. But hang in there. I will be there to support you through this journey. If you ever feel bad or uncomfortable, tell me. I will do everything that I can to help you through it and make therapy a safe space for you.
Benefits of Therapy:
Therapy has many benefits and can help you improve your daily quality of life. I trained as a therapist in order to support and communicate with clients in a way that helps them feel safe and feel heard. When a client feels safe and they feel like they have been heard, they can begin to work through issues that may be hard to think about or troubling to process. I see therapy as a journey for my clients and my job is to support you on your journey. To me, the purpose of the journey is for the client to find their best selves and live their best life.
Confidentiality and Privacy
The Therapeutic Relationship:
The relationship between the therapist and the client is a special relationship that has to be based on trust. In order to provide that trust at the beginning of our therapeutic relationship, we have to be on the same page with what privacy and confidentiality look like. In my practice, I use HIPAA and HITECH compliant software and communication. This means that none of your private information will be shared or in danger of being shared. The software and communication means are all encrypted and secured at the same standard as a doctor’s office or hospital.
Duty to Warn:
As a licensed therapist in Arkansas, I am a mandated reporter. This means that if I have information or witness a vulnerable person being hurt or in danger, I have to report it to the appropriate authorities. This may mean that I have to break confidentiality in order to report an incident. The only other times that I may have to break confidentiality is:
If you are planning to kill yourself.
If you are planning to hurt or kill someone else.
If there is information about child abuse or neglect, elder abuse or neglect, or vulnerable persons abuse or neglect.
If you are planning on destroying someone’s property (such as arson).
If I am ordered by the court.
In all other circumstances, I am bound to you by confidentiality and your privileged communication is protected by law in the state of Arkansas just as information between a lawyer and their client is protected. This law is 17-27-311. Privileged communication.
Policy Concerning Minors:
If you are a minor, this means that your parents or guardians own your information. However, I discourage parents and guardians from requesting their child’s information unless the child gives their assent, it is a matter of their safety, or in the best interest of the minor. Anytime that information from our work in therapy is going to be shared with a parent or guardian, I will discuss it with the minor before it happens. This helps me protect the trust that is built between myself and the minor in therapy and is important to our therapeutic relationship. It is my ethical obligation to look out for the well-being of my client unless there is a safety concern, a concern for the minor’s well-being, or if it becomes a legal matter.
Social Media Policy:
Because a therapeutic relationship is a different relationship than a friendship or a familial relationship there need to be professional boundaries so that you as the client are always protected. Because of these boundaries, we cannot be connected on any personal social media accounts or in any other public manner due to violations of your privacy. This can be confusing because the therapeutic relationship is a strong one, but it is still a professional relationship and requires adherence to strong boundaries for both of us.
Contact Outside of Business Hours:
I do not consistently check my phone when I am in session or outside of business hours. I will not always answer texts or calls that are not something that we have discussed beforehand. I will attempt to reply within 24 hours for emergencies or address the contact in our next session if it is not a pressing matter. Emailing me at [email protected] is the best way to reach me at any time. If you do have an emergency and are not able to reach me, call your local emergency services and 911 for support and assistance.
Session Privacy & Safety:
Because therapy is private and you and I may be talking about sensitive or vulnerable things, I ask that you only engage in a therapy session when you are alone and you can share comfortably and privately. I also want to make sure that you are safe anytime that we are having a therapy session so I will ask that you never engage in a therapy session while you are driving or participating in something that requires your full attention to be safe. If you and I begin a therapy session and you are not in a private space, or it is not safe for us to proceed we will have to set up another time to have our therapy session.
Technical Issues:
There may be times when sessions might be interrupted due to power or internet issues. If anything like this happens and we are disconnected, email me as soon as you are able and I will get back to you with a plan to pick up the session where we were interrupted. If this happens and you are having a crisis or an emergency, please call your emergency or support services first and then email me as soon as you are safe. You and I will work together to identify the emergency support and emergency services that you may need in your area during one of our first sessions.
General Information
Referrals:
As a clinician, it is my responsibility to determine when online counseling is appropriate and when it might not be the best fit. Since participating in online therapy means that you and I may be far away from each other during our sessions. If there are issues that you need to work on in therapy that requires services consisting of or related to disordered eating, severe suicidal ideation, history of suicide attempts, history of homicidal ideation, or aggression, serious drug use, and/or history of overdose. In these instances, I will find a referral that I believe to be a good fit for you and make sure that you get the information that you need to begin treatment with that referral.
It is important to engage in therapy with someone who considers your individual issues their specialty and something that they are really good at. There may also be cases when I may not be the best clinical fit for you. In these cases, I will also refer you to another clinician who I believe to be a better fit for your needs. I will always discuss this with you and make sure that you are comfortable with the transition. Good fit with your therapist is important because this is the person going with you on your journey. It is important that we are able to make that journey together healthy and not like two siblings arguing in the back seat on a road trip.
Session Details:
So, what will therapy look like? Online therapy will be you and me talking over a computer or smartphone. You will need to have an internet connection and a camera on your computer or smartphone, as well as microphone capabilities. Please make sure that your devices are charged and that your internet connection is stable in order to minimize the possibility of losing connection during our sessions.
In-person therapy will be you and me having a conversation in person in my office. My office is set up to allow the six feet recommended for social distancing. I will wear a mask during our sessions and ask that you do as well due to health and safety during the COVID pandemic. I know that masks in therapy are not ideal, but safety is important to me because our time together is important to me. I don’t want sickness to get in the way of that if I can help it.
Therapy sessions will be 50 minutes. Shorter therapy sessions are available if you need them but the price for each session will be the same. Sessions can be scheduled twice a week, weekly, bi-weekly, or once a month depending on what we agree upon. If I believe that you may need sessions more or less often, I will discuss this with you and make sure that you are comfortable before we change the frequency of our sessions.
I recommend weekly sessions for the first 3-6 months that we are meeting as this helps build rapport, offers continuity, and builds a solid foundation in your coping skills and growth.
Payments & Fees:
Payment for sessions will take place through Simple Practice. You will be able to add your debit or credit card to your client portal once you receive the initial email. Once your card is linked to the Simple Practice account, it will be automatically drafted for services at the end of each session. If you ever have any questions or concerns or need to discuss payments please do not hesitate to talk with me about it.
*If you are participating in therapy through the Open Path referral system or an adjusted price, session prices will be discussed during the first contact and will not be changed without notice and agreement.
No-Show:
Because I value your time as well as my own if we have a session scheduled and you do not make the appointment and you do not reschedule at least an hour beforehand, a session no-show fee will be charged to your card for the missed appointment time. I will wait for 15 minutes for you to log on to your session and after 15 minutes the appointment will be considered a no-show. This fee will apply after the second no-show. If you have more than two no-show appointments you may lose the preferred appointment time that we have agreed upon and will be required to schedule each week at a new session time.
Canceling within the hour of your session will result in a half session fee charge to your card.
*The no-show fee does not apply to sessions canceled or unattended due to true emergencies.
Court Involvement:
There are times when a court or judge will ask for a therapist to be present in court or submit paperwork for court cases. In the state of Arkansas, there is a statute § 17-27-311 – Privileged communication. This is to protect the therapist and client’s communications just as a lawyer and their client’s communications are protected.
If I am subpoenaed by the court I am still required to be present in court, but I cannot say anything unless I have permission from the client. I will not testify in court for custody cases and I am not a trained forensic clinician.
I do not provide any kind of testimony beyond a summarization for court reporting purposes with client permission. Some fees will apply to any requests for documents for court or my presence in court as this takes time away from my practice.
The fee for time spent preparing and attending court will be billed at the equivalent of a session fee per hour. This will all be discussed with you beforehand if my presence in court is requested.
Paperwork For Outside Agencies or Persons:
Paperwork for outside agencies or persons will also incur an extra fee as this can be time-consuming and requires that I use my credentials and influence for recommendations and reports. This may include, but is not limited to, summaries, reports, court reports, recommendations, letters to doctors or other clinicians, and/or documentation letters of diagnosis and treatment.
This also applies to phone calls and emails with other agencies or persons pertaining to your care and treatment. Any paperwork or contact with other agencies or persons requires a release of information signed by you specifying what information is to be shared and with whom. Requests, releases of information, contact, and documents will become part of your clinical file. All of these details will be discussed with you and agreed upon before contact is made with outside agencies or persons.
Reporting:
If you believe that something unethical or illegal has occurred during our work together and you do not feel comfortable discussing the situation with me, please contact my licensing board and let them know what is going on.
My licensing board can be contacted at Arkansas Board of Examiners in Counseling https://abec.statesolutions.us/ 1-501-683-5800
Once again, thank you for choosing The Daring Space for your therapy needs! I can’t wait to get started!
Notice of Privacy Practices
The Daring Space A Private Therapy Practice
Wynne, AR 72396
www.thedaringspace.com
NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. YOU MAY HAVE ADDITIONAL RIGHTS UNDER STATE AND LOCAL LAW. PLEASE SEEK LEGAL COUNSEL FROM AN ATTORNEY LICENSED IN YOUR STATE IF YOU HAVE QUESTIONS REGARDING YOUR RIGHTS TO HEALTH CARE INFORMATION. EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on 06/2019 ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE Under the Health Insurance Portability and Accountability Act of 1996 (hereafter, “HIPAA”), you have certain rights regarding the use and disclosure of your protected health information (hereafter, “PHI”).
I. MY PLEDGE REGARDING HEALTH INFORMATION:
I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain obligations I have regarding the use and disclosure of your health information.
I am required by law to:
Make sure that PHI that identifies you is kept private.
Give you this notice of my legal duties and privacy practices with respect to health information.
Follow the terms of the notice that is currently in effect. I can change the terms of this Notice, and such changes will apply to all the information I have about you. The new Notice will be available upon request, in my office, and on my website.
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.
For Treatment Payment, or Health Care Operations:
Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. I may also disclose your PHI for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your PHI, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your health condition. I may also use your PHI for operations purposes, including sending you appointment reminders, billing invoices and other documentation.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about you or your minor child(ren) in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
Psychotherapy Notes. I do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
For my use in treating you.
For my use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
For my use in defending myself in legal proceedings instituted by you.
For use by the Secretary of the Department of Health and Human Services (HHS) to investigate my compliance with HIPAA.
Required by law and the use or disclosure is limited to the requirements of such law.
Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
Required by a coroner who is performing duties authorized by law.
Required to help avert a serious threat to the health and safety of others.
Marketing Purposes.
I will not use or disclose your PHI for marketing purposes without your prior written consent. For example, if I request a review from you and plan to share the review publically online or elsewhere to advertise my services or my practice,
I will provide you with a release form and HIPAA authorization.
The HIPAA authorization is required in the instance that your review contains PHI (i.e., your name, the date of the service you received, the kind of treatment you are seeking or other personal health details). Because you may not realize which information you provide is considered “PHI,” I will send you a HIPAA authorization and request your signature regardless of the content of your review. Once you complete the HIPAA authorization, I will have the legal right to use your review for advertising and marketing purposes, even if it contains PHI. You may withdraw this consent at any time by submitting a written request to me via the email address I keep on file or via certified mail to my address. Once I have received your written withdrawal of consent, I will remove your review from my website and from any other places where I have posted it. I cannot guarantee that others who may have copied your review from my website or from other locations will also remove the review. This is a risk that I want you to be aware of, should you give me permission to post your review.
Sale of PHI.
I will not sell your PHI.
IV. USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons. I have to meet certain legal conditions before I can share your information for these purposes:
Appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
For health oversight activities, including audits and investigations.
For judicial and administrative proceedings, including responding to a court or administrative order or subpoena, although my preference is to obtain an Authorization from you before doing so if I am so allowed by the court or administrative officials.
For law enforcement purposes, including reporting crimes occurring on my premises. To coroners or medical examiners, when such individuals are performing duties authorized by law.
For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI in order to comply with workers’ compensation laws. For organ and tissue donation requests.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.
Disclosures to family, friends, or others:
You have the right and choice to tell me that I may provide your PHI to a family member, friend, or other person whom you indicate is involved in your care or the payment for your health care, or to share you information in a disaster relief situation.
The opportunity to consent may be obtained retroactively in emergency situations to mitigate a serious and immediate threat to health or safety or if you are unconscious.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
The Right to Request Limits on Uses and Disclosures of Your PHI.
You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full.
You have the right to request restrictions on the disclosure of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
The Right to Choose How I Send PHI to You.
You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
The Right to See and Get Copies of Your PHI.
Other than in limited circumstances, you have the right to get an electronic or paper copy of your medical record and other information that I have about you. Ask us how to do this. I will provide you with a copy of your record, or if you agree, a summary of it, within 30 days of receiving your written request. I may charge a reasonable cost based fee for doing so.
The Right to Get a List of the Disclosures I Have Made.
You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or health care operations, and other disclosures (such as any you ask me to make). Ask me how to do this. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost-based fee for each additional request.
The Right to Correct or Update Your PHI.
If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
The Right to Get a Paper or Electronic Copy of this Notice.
You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by email. And, even if you have agreed to receive this Notice via email, you also have the right to request a paper copy of it.
The Right to Choose Someone to Act For You.
If you have given someone medical power of attorney or if someone is your legal guardian, that person can make choices about your health information. The Right to Revoke an Authorization.
The Right to Opt out of Communications and Fundraising from our Organization.
The Right to File a Complaint.
You can file a complaint if you feel I have violated your rights by contacting me using the information on page one or by filing a complaint with the HHS Office for Civil Rights located at 200 Independence Avenue, S.W., Washington D.C. 20201, calling HHS at (877) 696-6775, or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints.
I will not retaliate against you for filing a complaint.
VII. CHANGES TO THIS NOTICE I can change the terms of this Notice, and such changes will apply to all the information I have about you. The new Notice will be available upon request, in my office and on my website.