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Parent Child Interactive Therapy - PCIT

Specialty Services for children - 2-7

PCIT  is a form of therapy is designed for parents and children to work together, strengthening their relationship while developing lifelong skills that promote calmness and emotional resilience. Contact us today to learn more about our services.

Child & Adolescent Consent Acknowledgement

Please review the following overview and sign the C & A consent acknowledgement below (new & current clients only):

1. Dual Parental/legal guardian Acknowledgement:
   - Both parents/legal guardians must sign the acknowledgement for their child to receive mental health services.
   - A PDF copy of the full consent, signed within our Electronic Health Record (EHR), can be provided upon request.

2. Custody Verification:
   - If separated or divorced, please provide the most recent custody decree demonstrating your authority to     

     authorize treatment for your child.

3. Zone of Privacy:
   - To foster a trusting therapist-child relationship, we share general information about your child's treatment.
   - Specific details disclosed by your child during sessions will not be shared without your child's consent.

4. Accessing Records:
   - The "zone of privacy" extends to treatment records.
   - By signing, you waive your right to access your child's treatment records, but a treatment summary can be

      provided upon request.

5. Adolescence Autonomy:
   - Adolescents may share sensitive information; confidentiality is maintained unless there's imminent harm risk.
   - You'll be informed of missed sessions or if a referral to another mental health professional becomes necessary.

 

6. Legal Disputes:
   - Clinicians won't be involved in legal disputes, especially custody, or visitation matters.
   - Clinicians won't testify in court, respecting ethical boundaries regarding not providing opinions on custody or

     visitation suitability.

7. Legal Fees:
   - In the event of clinician involvement in legal disputes, the responsible party agrees to reimburse at $200/hour

     for testimony, attendance, and any case-related costs.
   - Additional fees apply for report preparation, consultation or supervision, telephone calls, and travel time at the

     same rate.

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