Limits of Confidentiality: All information that you disclose to me within our clinical consultation is confidential and will not be revealed to anyone without your written permission or in my professional judgment, I believe that you present a professional risk to clients (e.g., impaired professional). Disclosure may be authorized or required by law:
Disclosure may also be required pursuant a legal proceeding.
Records: Your clinical consultation or supervision file will consist of (a) legal forms such as this document, (b) record of visits and payments, and (c) clinical consultation (or supervision) notes.
Education, Training, and Experience: I have an MSW in Social Work and have a valid license to practice as a Clinical Social Worker in Arizona (Lic. No. LCSW-17211) and Missouri (Lic. No. 2017038061). I am also a registered clinical supervisor in Arizona (No. 51364). While completing my MSW in Social Work, I also completed specialized training in Forgiveness Therapy, and I am one of the top graduates to have completed the APA accredited certificate program. Previous to my MSW, I earned an M.Ed. in Counseling Psychology and a B.S. in Disability Studies and have a valid certification to practice and supervise as a Rehabilitation Counselor nationwide (Cert. No. 111984). After receiving my MSW, I completed a Post-Graduate Fellowship in Psychoanalytic Thought and an ADA Coordinator Certification (Cert. No. 66935970-4617). Most recently, I have also earned the designations of Clinically Certified Domestic Violence Counselor (Cert. No. 29243), Certified Trauma Professional Level 2 (Cert. No. 578775), Certified Forensic Social Worker (Cert. No. 29243), Certified Storytelling Leader (Cert. No. cer-056c99d1-ae96-4e3b-b443-9a2bec), and Certified Autism Spectrum Disorder Clinical Specialist (Cert. No. 304356). I am also certified in Seizure First Aid (Cert. ID. nbapo4cajq). My clinical experience includes crisis intervention, hostage negotiation, evaluation and treatment of past abuse, trauma, domestic violence, intimate partner violence, sexual abuse, post-traumatic stress disorder (PTSD), psychogenic non-epileptic seizures (PNES), anger, depression, anxiety, addictions, and chronic pain; career counseling, case management, advocacy, accommodations of people who experience disabilities, blindness and visual impairments. My experience also includes treating medical conditions from the medical model, researching and writing policies and law, providing training and supervision for clinicians, counselors and other professionals, as well as standard of care and forensic expert related services.
Length and Success of Services: The length and success of clinical consultation and clinical supervision varies by the requirements of the law, the motivation and aptitude of the clinician, and the goals of the consultation or supervision. Therefore, I can make no guarantees. You are advised to check with your licensing or certification board to determine if I am qualified to provide you supervision for licensure, if you need it. If you do not need licensure or certification supervision, I may be able to offer my professional guidance. However, I will not provide advice on growing your business and managing your practice.
Risk of Services: You should be aware, although I anticipate otherwise, despite consultation and/or supervision, you may not improve at all, you may not improve as quickly as you may like, or you may start to improve only after clinical consultation or supervision has ended. Clinical consultation and supervision can also provoke feelings of affection for me or anger at me, and these experiences should be considered normal aspects of consultation/supervision, to be discussed openly with me.
You are advised to seek psychotherapy outside of the clinical consultation and supervision that you receive from me in order to help you to become one of the best clinicians, avoid doing harm to clients, and to help you with your emotional reactions towards me. You should also be aware that treatment is intended to induce change in your life, and that when this change occurs it may disrupt your accustomed manner of living and your relationships with others.
Your Rights: You may terminate services with me at any time, which may also include a report to the licensing or certification board. Please be sure to check with your licensing and certification board as to what the requirements are if you intend to use our time together towards licensure or certification.
In all cases, professional treatment never includes sexual contact with the clinical supervisor.
Couples and Family Therapy: Because I do not provide treatment to couples and families or for minor children, under the age of 18 years, I also do not provide clinical supervision in this area. I will, however, provide clinical consultation based on my experience, expertise, and what I have learned about working with couples, families, and minor children.
Legal Issues: I am an independent clinician, and when you come to me for clinical consultation and supervision, I will not get involved in legal testimony or progress reports to third parties, including through the Church for purposes of annulments. This is separate from what I do as a Forensic Expert.
Cost, Length, and Frequency of Clinical Consultation and Supervision: My general consultation fee is $150 per hour during the daytime and $175 per hour in the evening (if the consult begins at or after 6:00pm in Arizona) and for all concierge (on-site) services regardless of the time of day. Additional fees related to time and travel for concierge (on-site) services may apply for services outside of Flagstaff, AZ.
Sessions are usually an hour, but they can be any length, calculated at my hourly rate. I use 5-minute intervals, rounded to the next highest $5; with a minimum charge of $40. Please take note of my Payment for Services and Practice Policies for additional information.
Payment for Services: Payment can be in cash (which ensures confidentiality), by check, money order, bank draft, ACH transfer, or with a credit card. Some of these payment methods are only accepted through Square. You will be expected to pay at the time of service or in some cases, scheduling, unless other arrangements have been made. I will not prepare invoices for you, at your request, for purposes of billing, collecting payments, or “reminding” you to make a payment. In the event that there is a misuse of “other payment arrangements”, I reserve the right to require advance payment for all future sessions, use collections for past due balances, and/or terminate services.
In the event that it becomes necessary for me to prepare an invoice, in order to attempt to collect payments, you will be billed an additional $25 fee per invoice. This invoice will include the date and time of the session and the amount(s) past due. For costs that I incur from my bank due to checks or other methods of payment unpaid by your bank for any reason, you will be expected to reimburse me.
If, because of rising costs, I have to raise my fees, I will not do so for current clients; but any client who leaves services for more than a month and then decides to return to services will be charged the new fee.
Practice Policies: Scheduling of your first appointment will requirement advance payment and ALL initial consultations are conducted by phone, which may be scheduled through the “Book a Call” feature or by calling (928) 890-4642. If you choose to call me to schedule, rather than use the “Book a Call” feature, you will be required to make payment in the amount that is required based upon the time of day and the amount of time that you want to meet PRIOR to contacting me to schedule your appointment, or in the alternative, to make a minimum donation of $40 in Gratitude for My Website(s) prior to contacting me by phone or email to briefly discuss your concern, availability for scheduling, and how to make payment, which this phone or email correspondence shall not exceed 15 minutes. Note: If you make a donation, and you would like to schedule an appointment or explain your donation, I will not respond to the same email address that you used to make the donation.
Making a payment does not automatically guarantee that you get an appointment. That will need to be confirmed with me. [A donation is also not considered a payment for services.] The use of the online scheduling system to “Book a Call” will also require payment at the time of scheduling. All sessions must be scheduled in advance. My schedule does not allow for crisis counseling or crisis consultations.
You will be billed for sessions cancelled without a minimum of 24-hours advance notice for consultations that are scheduled with the use of technology (phone or video conferencing) and concierge (on-site) services within the city limits of Flagstaff, AZ. You will be billed for concierge (on-site) services cancelled without a minimum of 72-hours advance notice for consultations outside of Flagstaff, AZ.
You will be billed for missed sessions. If you are late, you will be billed for the entire session. If my schedule permits and you would like to continue past the time you previously scheduled, you will be billed for the additional time spent based on the prorated hourly amount, billed in 5-minute increments, rounded to the next highest $5.
I schedule appointments Monday-Saturday throughout the early morning, daytime, and late evening. I do not schedule appointments on Sundays. I also generally do not respond to texts, emails, or voicemails on Sundays.
Cancellation: The scheduling of an appointment involves the reservation of time specifically for you, and I will wait the entire time for you to arrive. If you are late, we will meet for whatever time remains. You will be required to pay for the full consultation. If you do not attend your scheduled virtual consultation, which may be done by phone, audio or video conferencing, and you have not notified me at least 24 hours in advance, you will be required to pay the full cost of the service.
If you do not attend your scheduled concierge (on-site) consultation within Flagstaff, AZ, and you have not notified me at least 24 hours, you will be required to pay the full cost of the consultation (one-hour minimum). If you do not attend your scheduled concierge (on-site) consultation outside of Flagstaff, AZ, and you have not notified me at least 72 hours in advance, you will be required to pay the full cost of the consultation, unless other arrangements have been made and signed in advance by both parties. If you have requested a concierge (on-site) service that requires me to reserve travel and/or lodging, those costs are due upfront and are non-refundable.
Texting: Because of the danger of privacy breaches, I discourage the use of text messages unless they are short, information specific, and do not refer to any psychological details. In the event that you elect to use texting, it is preferable to use the Signal app or iMessages due to the enhanced privacy settings and capabilities that each provide.
E-mail: I discourage the use of e-mail with established clients. If you choose to contact me through e-mail, please understand that e-mail is not a secure form of communication and that it can be intercepted by anyone at any time. If you elect to use the online “Book a Call” feature, you will receive a confirmation of your appointment, rescheduling or cancellation of appointments. If you elect to pay with a credit card or ACH via Square, you will receive a confirmation receipt via email. Any initial invoicing to collect past due balances is also sent to your email via Square.
Audio and Video Conferencing: In addition to phone calls, I use the new Google Meet app (powered by Google Duo), which will require that you to initiate a call to me from your number at the specified time of your appointment, in order to enable end-to-end encryption. If you have the old version of Google Meet on your device, you will need to uninstall it and reinstall it prior to any video conferencing or tele-health appointments to occur. I can also use Google Meet and Microsoft Teams with what is known as Transport-Layer-Security (TLS) or during transit level of encryption because I have what is known as a Business Associate Agreement (BAA) with Google and Microsoft, respectively. I do not use any other service for clinical consultation or clinical supervision because I have not been able to find another service that is HIPAA compliant, while also being user-friendly. Microsoft Teams may add a true end-to-end encryption as early as February 2023; however, I do not have confirmation at this time.
I do not use what is known as the Client-Side-Encryption with one of Google’s partners at this time because my research indicated that all of their partners use vague language about the Health Information Portability and Accountability Act (HIPAA) regulatory requirements and how they ensure that the client (Gianna Elms, LCSW) would be in compliance by using their service as a partner with Google, even if I were to sign a BAA with them. Therefore, I am not convinced at this point in time that it actually provides a higher-level of encryption or security based on the HIPAA protections that you may have according to the law, from what I know as of this date. If something changes, I will change my policies at that time.
Business Associate Agreements: I have what is known as a Business Associate Agreement (BAA) with necessary individuals and entities related to my websites, scheduling software, video conferencing, email, payment processing, travel, accounting, and technology related support and repair in order to protect your privacy and to be in compliance with HIPAA. While I do not keep electronic records, your identifying information is may be considered Protected Health Information (PHI) because of the information that you share with me about clients or yourself, even though I don’t have the same responsibility to you personally, I do have it for your clients, and your participation in video conferencing, texting, email, and so forth may all be considered PHI under the law. Therefore, I have made every reasonable effort to advise you and my clients about what to avoid, while also working to make my services accessible, and putting every reasonable protection in place to protect the privacy of you and your clients. Privacy, safety, and healing are my top priorities.
[Revised February 2023]