INFORMED CONSENT

 Chaplain Family Life Center, Fort Stewart/Hunter AAF, GA

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1. Background. Soldiers and family members during the COVID-19 pandemic continue to request online pastoral counseling. Soldiers and family members also request online counseling while separated or deployed. Online counseling is an alternative means only to be used when face-to-face counseling is unavailable.

2. Confidentiality. This center complies with the U.S. Army Chief of Chaplain’s policy on confidential and privileged communication (para 16-2 of AR 165-1). All information clients disclose to chaplains is considered to be a religious act and therefore confidential. Confidential information between client and chaplain is considered privileged communication for legal purposes. Privileged or confidential communication will only be released with written consent from the client(s). The Fort Stewart/Hunter AAF Family Life Chaplain will conduct online counseling using his personal computer from either at his home or from the Fort Stewart Family Life Ministry Center using a HIPAA compliant video-counseling platform called Doxy.me.

3. Records. The Family Life Chaplain will continue to record sessions with written counseling notes. All counseling note documents will be secured in a “double locked” security system either in the chaplain’s private residence or back at the Family Life Ministry Center, depending where the Family conducts the distance counseling from. All written records will be destroyed upon termination of the counseling relationship.

4. Safety. All clients will engage in a safety check by briefly showing the room where they are located as well as confirming their local address and nearest hospital to their current location. This will allow the chaplain to take appropriate emergency measures if needed.

5. Technology.

        a. Pastoral counselors will use only HIPPA compliant video conferencing software with point-to-point encryption. Counselor and client will ensure AES 256 bit encryption is           

            selected on their devices.

        b. The client is responsible for securing their own computer hardware, internet access points, and password security. The use of a cell phone is not recommended.

        c. The client will be responsible for confidentiality in their environment. If client chooses to conduct online counseling from home or work, they must ensure they are in an indoor    

            private location (office or a room with the door and windows closed) conducive to a confidential conversation. Headphones are helpful and advised. The location should be stable, 

            static and safe (no driving or walking during therapy).

        d. The Family Life Chaplain is not liable for confidentiality breaches caused by client error or environmental factors nor are they responsible for client’s equipment failure.

6. Connectivity. If video services are not available due to an unplanned equipment or service malfunction, sessions will occur via telephone or rescheduled via email. Please provide the most appropriate phone number at the start of the session in the event of technology issues.

7. Recording. Clients will not make audio or video recordings of any portion of the sessions. Clients may take written notes.

8. Client Risk.

       a. Online counseling is not a crisis based clinical service.

       b. Online counseling may not be appropriate for clients with active suicidal or homicidal thoughts or clients who are experiencing acute mental health problems such as manic or 

           psychotic symptoms.

       c. It is the client’s responsibility to inform their counselor if they are at risk of harm to self or others.

       d. At intake, a client who reports being at risk of harm to self or others will be assessed for risk level and provided safety planning. Based on the assessment, a client may be 

           recommended to seek help at the nearest hospital emergency room or referred to a traditional face-to-face counseling program or provider.

        e. If a client who was not formerly at risk, should become at risk of harm to self or others, they should immediately report it to their therapist. In such cases, a client may be 

            recommended to seek help at the nearest emergency room or referred to a traditional face-to-face counseling program or provider.

9. Consent. I understand the risks and limitations to online counseling. By signing this consent, I agree to abide by its content.

 

 

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Client Printed Name                           Client Signature                          Date

 

 

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Counselor Printed Name                     Counselor Signature                   Date