Parent / Guardian Informed Consent for Treatment of a Minor Child

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Special Considerations in Consent to Treatment of a Minor Child

Prior to beginning treatment, it is important for you to understand the therapist’s approach to child therapy and agree to some rules about your child’s confidentiality during the course of his/her/their treatment.
The information herein is in addition to the information contained in the informed consent you have / will agree to.

Confidentiality & Reporting

It is our policy to provide you with general information about treatment status. The therapist will raise issues that may impact your child either inside or outside the home. If it is necessary to refer your child to another mental health professional with more specialized skills, the therapist will share that information with you. If over the age of 14, the therapist will not share with you what your child has disclosed to him/her/them without your child’s consent.

If your child is an adolescent, it is possible that he/she/they may reveal sensitive information regarding sexual contact, alcohol and drug use, or other potentially problematic behaviors. Sometimes these behaviors are within the range of normal adolescent experimentation, but at other times they may require parental intervention. If the therapist ever believes that your child is at serious risk of harming him/herself/themself or another, the therapist will inform you and / or engage additional resources.

Parents Role(s)

Although the therapist’s responsibility to your child may require his/her involvement in conflicts between the two of you, the therapist needs your agreement that his/her involvement will be strictly limited to that which will benefit your child. This means, among other things, that you will treat anything that is said in session with the therapist as confidential. Neither of you will attempt to gain advantage in any legal proceeding between the two of you from the therapist’s involvement with your children. In particular, the therapist needs your agreement that in any such proceedings, neither of you will ask the therapist to testify in court, whether in person, or by affidavit. You also agree to instruct your attorneys not to subpoena the therapist or to refer in any court filing to anything the therapist has said or done. Having your child see a therapist with our group means that you understand that the therapist’s role is not as an evaluator (not hired as a custody evaluator) and therefore cannot give opinions. Note that such agreement may not prevent a judge from requiring the therapist’s testimony, even though the therapist will work to prevent such an event. If the therapist is required to testify, the therapist is ethically bound not to give his/her/their opinion about either parent’s custody or visitation suitability. If the court appoints a custody evaluation, guardian ad litem, or parenting coordinator, the therapist will provide information as needed (if appropriate releases are signed or a court order is provided), but the therapist will not make any recommendation about the final decision. Furthermore, if the therapist is required to appear as a witness, the party responsible for the therapist’s participation agrees to reimburse the therapist at the rate of $150.00 per hour for the therapist’s time spent traveling, preparing reports, testifying, being in attendance, and any other care-related costs

Parent / Guardian Name*

First Last

Date*

Signature*

Parent / Guardian Name

First Last

Date

Signature

Parent / Guardian Consent for Treatment of a Minor Child