Informed Consent, Client Rights, and Clinic Policies and Procedures

Professional credentials for Samantha Davidson, MSW, RSW:

  • Licensed as: Registered Social Worker, Psychotherapist in the province of Ontario.
  • Registration Number: 833586 Ontario College of Social Workers and Social Service Workers (OCSWSSW)

Education:

  • Degree: MSW, BSW
  • Institution: Carleton University
  • Year: 2019

Professional Background:

  • Years in Practice: 8
  • Theoretical Orientation: Trauma-focused, Anti-Racist, Anti-Oppressive, Integrative, Relational, Psychodynamic, Holistic, Feminist, Structural
  • Treatment Approaches: ACT, CBT, DBT, EFT, EMDR, Internal Family Systems, Narrative Therapy, Mindfulness, Motivational Interviewing, Solution-focused, Somatic, Relational
  • Areas of Specialization: Anxiety, Childhood Developmental Trauma, CPTSD, Depression, Emotion Regulation, Family Conflict, Grief, Life Transitions, PTSD, Relationship Issues, Stress/Burn-out.

Professional Affiliations:

  • Member of: Canadian Association Of Social Workers, Ontario Association of Social Workers.

As a registered professional, I am regulated by the Ontario College of Social Workers and Social service Workers (OCSWSSW), which ensures that I adhere to professional standards of practice and ethical guidelines. Should you have any concerns about my professional conduct, The Ontario College of Social Workers and Social service Workers (OCSWSSW) can be contacted at:

Phone: 1-416-972-9882 

Toll-Free: 1-877-828-9380 

Email: info@ocswssw.org

THE THERAPEUTIC PROCESS

Psychotherapy is a collaborative process between you and your therapist designed to help you address concerns, cope with difficulties, and work toward your goals. There are many different methods your therapist may use to assist you in your efforts. Therapy requires active effort on your part. This may include being vulnerable and honest, reflecting on things we discuss during sessions, and trying out new ways of thinking and being. You will be outside of your comfort zone at times.

Assessment and Treatment Planning

Our first few sessions will be time for us to build a relationship and create a place of safety to work from. This will include taking a history of your life, and evaluating your current needs and presenting concerns. From there, we will create a treatment plan and develop goals for our work together. Throughout our time together we will review progress and, if necessary, revise our approach.

Benefits and Risks

Therapy has both benefits and risks. Potential benefits include significant reduction in feelings of distress, improved relationships, increased capacity for intimacy, greater personal clarity, increased sense of control over your life, and improved ability to cope with stressors. Risks may include experiencing uncomfortable feelings such as sadness, guilt, anxiety, anger, frustration, loneliness, or helplessness. Therapy often involves discussing unpleasant aspects of your life and may lead to decisions that can be disruptive or distressing.

Some changes resulting from therapy may not be intended. For example, as you become more aware of personal patterns, this may impact how you see yourself and your relationships. There is also a risk that, as you make changes to your life, people close to you may feel uncomfortable and there could be conflict during these transitions.

There is a risk that therapy may not yield the desired changes or that problems might worsen temporarily.

There are no guarantees for positive outcomes in therapy. However, most people who remain actively engaged in the therapeutic process find that it is beneficial. You have the right to ask questions about anything that happens in therapy and to discuss your progress in treatment with me. You are also free to decide not to follow my recommendations and to discontinue our work together at any time.

Length of Therapy

The length of therapy depends on your specific needs and goals. Some clients need only a few sessions to resolve specific issues, while others may benefit from longer-term therapy to address more complex patterns or achieve more substantial personal growth. We will periodically discuss your progress and determine together whether continued therapy is necessary or appropriate.

PROFESSIONAL RELATIONSHIP

Therapeutic Relationship

The relationship between therapist and client is professional rather than social. Contact will be limited to sessions you arrange with your therapist. Your therapist will not attend social gatherings, accept gifts, or have any relationship beyond the professional context of our therapy sessions. These boundaries are important for effective therapeutic work.

Multiple Relationships

It is important that our relationship remain therapeutic and professional. In some small communities, you may know or come to know someone who also seeks services with me. I cannot acknowledge either therapeutic relationship without proper consent. If we see each other in public, I will not acknowledge you unless you acknowledge me first, in order to protect your confidentiality.

CONFIDENTIALITY

Your personal health information is protected by professional ethics and legal regulations in Ontario such as the Personal Health Information Protection Act (PHIPA). All information disclosed within sessions, and the written notes pertaining to those sessions, are confidential and may not be revealed to anyone without your written permission, except where disclosure is required by law.

FreeBird Counselling maintains secure electronic health records in compliance with provincial privacy legislation, including the Personal Information Protection and Electronic Documents Act (PIPEDA) and other provincial privacy legislation.

I cannot and will not disclose information about your treatment without your written permission, with the following exceptions:

Limitations to Confidentiality

  1. Risk of harm to self or others: If I have reason to believe that you are at risk of harming yourself or another person, I am obligated to take protective actions, which may include contacting family members, emergency services, potential victims, and/or the police.
  2. Suspected abuse or neglect: If I have reasonable cause to believe that a child, elderly person, or vulnerable adult is being abused or neglected, I am required by law to report this to the appropriate authorities, such as Child Welfare or Adult Protective Services.
  3. Legal proceedings: If you are involved in legal proceedings, your records may be subject to subpoena or court order. While I will make every effort to protect your privacy, I must comply with valid court orders.
  4. Insurance billing requirements: If you are using insurance, I may be required to provide certain information to your insurance company, such as a diagnosis, treatment plan, or treatment summary.
  5. Professional consultation: I may occasionally consult with other professionals about aspects of your case to provide the best possible care, but I will not reveal your identity without your consent.

CLIENT RIGHTS

As a client, you have the right to:

  1. Receive respectful treatment that will be helpful to you
  2. A safe treatment setting free from discrimination, sexual, physical, and emotional abuse
  3. Ask for and get information about your therapist’s qualifications, including their registration, education, training, experience, membership in professional groups, special areas of practice, and limits on practice
  4. Have written information about fees, methods of payment, insurance coverage, number of sessions, substitutions (in cases of vacation and emergencies), and cancellation policies
  5. Refuse treatment or recommendations from your therapist
  6. Refuse electronic recording of sessions
  7. Request that the therapist inform you of your progress
  8. Know the expected length of treatment and be informed of risks and benefits of therapy
  9. Report unethical and illegal behaviour by a therapist to their regulatory college
  10. Request and receive a copy of your records, including the diagnosis, treatment plan, progress, and type of treatment
  11. Request the correction of errors in your record
  12. Have your records kept confidential except in the circumstances outlined in the confidentiality section
  13. Terminate therapy at any time

FEE SCHEDULE:

  • Initial assessment: $160.00
  • Individual therapy: $160.00
  • EMDR therapy: $160.00
  • EMDR therapy 90 minute session: $240.00
  • Couples/family therapy 60 minute session: $210.00
  • Group therapy (per session): TBD
  • Consultations (up to 20 minutes): No charge
  • Report writing/letter writing: $40 per document
  • Records review: $40 per hour
  • No shows/ +15 min late: full session cost
  • Late cancellation fee (under 24hrs): $80 – $120 (1/2 the cost of type of session booked)

Fees are subject to periodic review and may change. You will be notified of any fee changes at least 30 days in advance

PAYMENT AND INSURANCE

  • Payment is due at the time of service
  • Accepted payment methods: e-transfer, credit card, cash
  • Provincial health insurance: Most psychological services are not covered by provincial healthcare
  • Extended health insurance: Mental health services may be covered by your extended health benefits plan. You are responsible for verifying your mental health coverage prior to your first session
  • FreeBird Counselling offers direct billing to the following health insurance providers: Blue Cross, SunLife
  • Receipts provided for insurance reimbursement and tax purposes
  • Please note: Health insurance benefits will not cover the cost of missed sessions, that is your responsibility

COMMUNICATION

  • For scheduling/administrative matters: Call 613-326-1468 or email hello@freebirdcounselling.com
  • Messages will be returned within 24-48 business hours (unless you receive and out-of-office notification)
  • FreeBird Counselling currently books in-person and virtual sessions. You must be physically present in Ontario to access counselling services at FreeBird Counselling, including virtual services.

SOCIAL MEDIA AND TELECOMMUNICATION

Due to the importance of your confidentiality and the importance of minimizing dual relationships, our providers do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). We believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of the therapeutic relationship. If you have questions about this, please bring them up with your therapist. Please read and sign both our Privacy Policy and Social Media Policy prior to your first appointment. 

ELECTRONIC COMMUNICATION

We cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, we will do so.

Email and text messaging should be limited to scheduling, billing questions, and other administrative matters. Please do not use email or text messaging to discuss clinical matters as these are not secure forms of communication.

While we will try to return messages in a timely manner, we cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

TELEHEALTH SERVICES

  • Telehealth services are available for eligible clients.
  • Telehealth sessions are billed at the same rate as in-person sessions.
  • Insurance coverage for Telehealth varies by plan. Please check with your insurance provider regarding Telehealth benefits.
  • You must be physically located in Ontario during Telehealth sessions, as our providers are licensed in Ontario.
  • Technical requirements include a reliable internet connection, a device with camera and microphone capabilities, and a private location.
  • In case of technical difficulties, we will continue the session by phone.
  • Please refer to our Telehealth Consent Form for detailed information.

PROFESSIONAL RECORDS

We are required to keep appropriate records of services provided. These records include dates of service, assessments, treatment plans, progress notes, and billing information.

You have the right to request access to your records or a summary of your care. Records are maintained for 10 years as required by provincial law and professional standards. Records may be released to third parties only with your written authorization or as required by law.

COORDINATION WITH OTHER HEALTHCARE PROVIDERS

  • With your written consent, we may communicate with your family physician, psychiatrist, or other healthcare providers to coordinate your care.
  • If you are prescribed medication by a psychiatrist or physician, we recommend regular communication between providers to ensure coordinated care.
  • Please complete a Consent to Release Information form for each provider with whom you would like us to communicate.

TERMINATION

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 treatment.

Therapy may be terminated when treatment goals are met or when either the client or therapist determines that treatment is no longer beneficial.

FreeBird Counselling reserves the right to terminate services if:

  • You no longer need or are benefiting from treatment
  • You have missed multiple appointments
  • You have an outstanding balance without a payment arrangement
  • You have violated clinic policies
  • Your needs are outside our scope of practice or competence

If services are terminated for any reason, we make an effort to direct you to other helping professionals as needed or desired.

Should you fail to schedule an appointment for 6 consecutive months, unless other arrangements have been made in advance, for legal and ethical reasons, we must consider the professional relationship discontinued.

EMERGENCY PROCEDURES

If you are experiencing a life-threatening emergency, please call 911 or present at your local emergency room. 

It is important to note that FreeBird Counselling does not offer crisis services. Please do not use telephone voicemail, e-mail, texts, social media, or the Jane app for emergencies as they are not monitored 24-7. 

Local mental health crisis lines.

  • During business hours: Lanark County Mental Health Crisis Services at 613-283-2170
  • After hours: Distress Centres Lanark, Leeds & Grenville 1-800-465-4442
  • Call or text The Suicide Crisis Line at 9-8-8
  • Ontario Crisis Line Info: Call 211
  • 1-877-825-9011 24/7
  • National Crisis Resources: Crisis Services Canada: 1-833-456-4566 or text HOME to 686868

CLIENT FEEDBACK AND CONCERNS

We value your feedback about your experience with our services. If you have concerns about your treatment, we encourage you to discuss them with your psychotherapist. If you are unable to resolve concerns with your psychotherapist, or you do not feel comfortable or safe to bring up your concerns, you have the right to file a complaint with our provincial regulatory college:

Ontario College of Social Workers and Social Service Workers

Telephone: 416-972-9882 

Toll-Free: 1-877-828-9380 

Email: info@ocswssw.org.

CHANGES TO POLICIES

FreeBird Counselling reserves the right to change any of the policies described above. We commit to having our latest adopted policy available here on our website and to providing clients with notice of any changes to policies.