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Consent for Care

Students must voluntarily complete consent paperwork prior to their first session or initial evaluation. Consent forms verify that students understand the expectations from services and that they may terminate clinical services and this consent at any time. All forms will be signed and maintained electronically.

Informed Consent

WELCOME: Counseling and Psychological Services (CAPS) offers a wide range of educational and psychological services to students, addressing concerns in the areas of personal development, mental health, cultural issues, life planning, stress management and achievement of educational goals. Services are provided by licensed clinicians, doctoral psychology interns and graduate students.

SCOPE OF PRACTICE: CAPS works within a short-term counseling framework and offers individual, relationship and group therapy. You and your counselor will meet to determine the best services to fit your needs. CAPS Group Programs are long-term and meet weekly for those preferring consistent weekly appointments and longer-term care. If it is decided that there are other agencies that can better meet your needs, our Case Manager or your counselor will provide resource information and/or appropriate referrals.

ELIGIBILITY: All registered students at UNL are eligible for services. One follow-up counseling session is allowed the semester immediately after the last semester as an enrolled student.

CONFIDENTIALITY: Strict confidentially is always maintained. No information may be released without written Release of Information from the student except in response to a court ordered subpoena or as otherwise required by law. We are required by law to report suspected child abuse or situations indicating imminent danger to self or others. According to Licensing Requirements, Professional Standards, and Nebraska Court precedent, counselors and psychologists also have a duty to warn as addressed by Statutes 38-3132 & 38-2137. Confidentiality may, therefore, need to be broken in these situations (Statutes 38-3131 & 38-2136). In addition, according to the Family Educational Rights and Privacy Act (FERPA), disclosures may be made to “appropriate persons, including university officials and parents of an eligible student” in connection with an emergency if knowledge is necessary to protect the health and safety of the student or other individuals.

CAPS coordinates care with the University Health Center (UHC) clinic on a need-to-know basis. This occurs when a CAPS client is being seeing for medication management at the UHC clinic or when urgent client care coordination is needed between UHC and CAPS.

CAPS uses electronic data storage and fax machines. Client records are accessible only to CAPS staff and only on a need-to-know basis. All electronic records are subject to confidentiality restrictions. No record of a student using CAPS services is kept in their official university records, placement file, or on their official transcript.

MINOR: If you are 17 years of age or younger, please inform your counselor, as additional limits on confidentiality may apply and your counselor will need to ask your parent or guardian to sign a form to consent to your treatment. While Nebraska law recognizes that minors and legally incapacitated individual cannot give informed consent, counselors still have a duty to maintain the confidentiality of a minor's information and records. This does not mean that the counselor may not discuss his/her evaluation and recommendations with a minor's parent/legal guardian or with a court of law. Under Nebraska law, minors cannot be seen for treatment unless they have their parents or legal guardian sign a consent form. In addition, a minor can only be seen for crisis related services without needing consent from their parent or legal guardian.

HOURS, APPOINTMENTS, AND EMERGENCY COVERAGE: From 8:00 a.m. to 5:00 p.m., Monday through Friday, students can call 402-472-7450 or come to Counseling and Psychological Services on the second floor at the University Health Center and College of Nursing Building to make an appointment. Afterhours emergency service information is available by calling 402-472-7450 and selecting Option 4 to talk with our on-call counselor. PLEASE NOTE: CAPS is closed during University Holidays and when the University is closed (e.g., Inclement Weather Days, Holiday Closedown).

COST FOR SERVICES: There is no charge for individual or group counseling. There are charges for some services (e.g., mandated alcohol/drug services). Please talk with your counselor if you have questions about any billed services.

MISSED APPOINTMENTS: If you cannot keep a scheduled appointment, please call CAPS (402-472- 7450) at least 24 hours in advance to cancel or reschedule. Please leave a message on the confidential voicemail if calling after hours. This is a very important courtesy for you to extend to other students, as letting our office know that you will not be keeping your appointment can make time available for someone else. Failure to cancel or reschedule your appointment at least 24 hours in advance will result in a no-show fee of $25.00.

PLEASE NOTE: All fees for no shows and other billed services are applied to your Student Account monthly. The item line will be listed as CAPS with a total amount due.

RISKS AND BENEFITS: Receiving counseling entails risks and benefits. Counseling may involve the risk of remembering unpleasant events and may arouse strong emotions. The benefits from counseling may allow the student to better cope with relationships and gain a better understanding of themselves, their values, and goals. This may lead to greater personal growth.

RESEARCH: I understand that de-identified aggregate data may be used for survey purposes (e.g., number of students presenting with depression) and that participation in this research involves no anticipated risks.

OTHER INFORMATION: Students seeking services in CAPS who believe that they may have a disability are encouraged to engage their counselor in a confidential discussion of their individual needs for academic accommodations. For information regarding accommodation services, students will be encouraged to contact the Services for Students with Disabilities (SSD) office, 117 Louise Pound Hall; 402-472-3787.

YOUR RIGHTS: You have the right to competent and professional services that includes an explanation of diagnoses and recommendations for treatment. You have the right to be treated with respect at CAPS. You have the right to a therapeutic relationship without physical, sexual, verbal, or other abuse or exploitation. You have the right to file a complaint. You have the right to evaluate our services. You have the right to request to review or release your clinical file. Relationship therapy files belong to all members of the relationship. Therefore, we will need all parties to sign a release of information before any information from the file is released to a member of the relationship or to a third party.

YOUR RESPONSIBILITIES: You are responsible to be an active and collaborative participant in your experience at CAPS. Students are expected to demonstrate respect for their counselor and to be honest in their communication. This allows the CAPS counselor to best assist your needs and to be responsive of your requests. Please communicate your needs with your counselor in a timely manner.

Telehealth Consent

INTRODUCTION: The University of Nebraska-Lincoln CAPS offers telehealth via HIPAA-compliant Zoom videoconferencing as an alternative to in-person services for certain situations. CAPS is unable to ensure complete confidentiality if you consent to communication through this platform, as it is limited in technological security. If you have any questions about the limits of confidentiality related to Zoom videoconferencing, please discuss this with your counselor. Please read the following carefully.

TELEHEALTH SERVICES: Telehealth services means the remote delivery of counseling and psychotherapy services via technology-assisted media. CAPS uses a HIPAA-compliant form of Zoom videoconferencing.

PRIVACY: CAPS will take every precaution to ensure a technologically secure and environmentally private appointment by conducting the session from a secure space in order to maintain confidentiality.

CLIENT RESPONSIBILITIES: Please be aware that, as a client, you are responsible for finding a private and quiet location where your session may be conducted uninterrupted. You have responsibility for maintaining the confidentiality of your Wi-Fi connectivity link and the security of your electronic device (tablet, phone, or computer). In rare cases security protocols could fail and your private information could be accessed by unauthorized person.

ACKNOWLEDGMENTS:

  • First Appointments
    I understand that my first appointment is an on-site, in-person appointment with a CAPS counselor. The counselor will inform you if telehealth is clinically appropriate or if it is contraindicated for your needs at this time.
  • About Recording Sessions:
    You are not permitted to record remote sessions, and all information disclosed within those sessions, and the written records of those sessions, are protected by the standards of clinical confidentiality as disclosed in our general consent form.
  • Location of Client During Session:
    You may only engage in remote counseling when you are physically located in Nebraska.
    You must provide CAPS a current and verifiable emergency contact person. If CAPS (i.e. your counselor) believes you are in crisis and we are unable to contact you, we may call your emergency contact or local emergency services providers.
  • After-Hours Services:
    If you are in crisis outside the normal business hours of 8 a.m. to 5 p.m. (or during campus closures) you agree to call CAPS at 402-472-7450 and follow the prompts to speak with the on-call counselor. If you are in imminent danger to yourself or others, call 911, call the UNL police department at 402-472-2222, or go to the nearest hospital emergency room.
  • In Case of Technology Failure:
    If your scheduled appointment is prevented or disrupted due to technical complications, please call CAPS. Your counselor will also attempt to call you.

Let's Talk Informal Consultations: In-Person Consent

Counseling and Psychological Services (CAPS) is excited to be able to offer brief, informal consultations through Let’s Talk! Please read the following information completely and carefully and feel free to ask questions. Then, complete the required information and sign below to indicate you have read and understood this information and consent to a Let’s Talk consultation:

Let’s Talk drop-in hours are available in various campus locations to help provide more informal consultations for students in need of brief personal support/or referral information about resources at CAPS and/or in other departments on campus. These last around 20-30 minutes.

During Let’s Talk drop-in hours, you will not receive clinical care, a psychological evaluation, a diagnosis, or a treatment plan. Your interactions with one of the CAPS staff during Let’s Talk drop-in hours does not constitute professional counseling/therapy or mental health treatment; however, after you leave today, a brief note with this signed consent form will be documented. Documentation related to any services that you receive from any aspect of CAPS does not become part of your academic or other university records.

CAPS adheres to professional, legal, and ethical guidelines of confidentiality during Let’s Talk drop-in hours. Therefore, your consultation today is confidential unless otherwise authorized by applicable law including, without limitation, situations such as allegations of child or elder abuse, or risk of immediate danger or harm to self or others.

  1. I understand that I will be provided with limited consultation services during my Let’s Talk consultation.
  2. I understand that although my consultant may be a mental health provider from CAPS, they are not providing psychological services during my Let’s Talk consultation.
  3. I understand that I can receive psychological services by calling CAPS at (402) 472-7450 and the front desk will assist me.
  4. I understand that I can discontinue this consultation at any time without affecting my right to future Let’s Talk consultations and/or psychological services at CAPS.
  5. I understand that if I am in an immediate crisis, I should call CAPS at (402) 472-7450 during regular business hours (8:00 A.M.-5:00 P.M., Monday through Friday) for assistance. For an urgent need or if you find yourself in crisis after business hours, I will call the same number (402) 472-7450 and select option 4. You can also access face-to-face emergency services by going to your nearest hospital emergency department or call 911.
  6. I understand that CAPS adheres to professional, legal, and ethical guidelines of confidentiality during my Let’s Talk consultation, while also understanding the limits to confidentiality as stated above.

Let's Talk Informal Consultations: Virtual Consent

Let’s Talk consultations are available virtually at different times throughout the week to help students who are in need of brief personal support/or referral information about resources at CAPS and/or in other departments on campus. These consultations last around 20-30 minutes and you may need to wait in the Zoom waiting room until the CAPS consultant is finished with another consultation before you.

During Let’s Talk consultations, you will not receive clinical care, a psychological evaluation, a diagnosis, or a treatment plan. Your interactions with one of the CAPS staff during the Let’s Talk consultation does not constitute professional counseling/therapy or mental health treatment; however, after you finish today, a brief note with this signed consent form will be documented. Documentation related to any services that you receive from any aspect of CAPS does not become part of your academic or other university records.

CAPS adheres to professional, legal, and ethical guidelines of confidentiality during Let’s Talk consultations. Therefore, your meeting today is confidential unless otherwise authorized by applicable law including, without limitation, situations such as allegations of child or elder abuse, or risk of immediate danger or harm to self or others.

  1. I understand that I will be provided with limited consultation services during my Let’s Talk consultation.
  2. I understand that although my consultant may be a mental health provider from CAPS, they are not providing psychological services during my Let’s Talk consultation.
  3. I understand that I can receive psychological services by calling CAPS at (402) 472-7450 and the front desk will assist me.
  4. I understand that I can discontinue this consultation at any time without affecting my right to future Let’s Talk consultations and/or psychological services at CAPS.
  5. I understand that if I am in an immediate crisis, I should call CAPS at (402) 472-7450 during regular business hours (8:00 A.M.-5:00 P.M., Monday through Friday) for assistance. For an urgent need or if you find yourself in crisis after business hours, I will call the same number (402) 472-7450 and select option 4. You can also access face-to-face emergency services by going to your nearest hospital emergency department or call 911.
  6. I understand that CAPS adheres to professional, legal, and ethical guidelines of confidentiality during my Let’s Talk consultation, while also understanding the limits to confidentiality as stated above.

In order to have the most successful virtual consultation, CAPS requests the following of students:

  1. Dress and prepare for the consultation similarly to an in person visit.
  2. Use a secure Wi-Fi/internet connection rather than a public or free Wi-Fi.
  3. Be in a private setting, alone and with the door closed.
  4. Try your best to eliminate distractions: put “do not disturb” on your door, turn off your phone, turn off your alerts on your computer, etc.
  5. Try your best to limit potential distractions such as children, email, pets, etc.
  6. Use headphones/earbuds so that what your CAPS consultant suggests to you is more protected.
  7. Connect to Zoom using both video and audio unless there is an issue with the technology.
  8. Do not record the consultation.
  9. Look at the screen/camera to show you are attentive.
  10. If possible, sit at a desk with your device at face level.
  11. If possible, use a larger screen than the size of a cell phone.
  12. Sit with the light source behind your camera, so that your face is visible. Try to avoid sitting with your back to a window because that will lead to too much shadowing.

Remember that by moving to a technology-based service, we will lose things we take for granted in an in-person format, such as non-verbal cues. Bandwidth can offer some additional disruptions and images can lack detail. There is room for misinterpretation by both the CAPS consultant and you. Please clarify with them if you feel misunderstood. They may also ask for clarification.

If there are technological issues that disconnect you from the consultation, please try to re-join. If you are unsuccessful in re-joining, the CAPS consultant will attempt to call you at the phone number you provided.