Consent to Service

I agree to have Compass provide child and youth mental health services, which may include a single session; observation; assessment; intervention planning; case management; and individual, family, and/or group intervention or therapy. Services may be provided at Compass sites, in the home, school, and/or community settings. Depending on the service, the evidence-based practice utilized will be tailored to the needs of the child/ youth and be mutually agreed upon with Compass staff. Compass staff may consult with Clinical Supervisors, Clinical Managers, and psychology staff to support delivery of services. Consultation may involve the disclosure of personal health information; however, the assigned staff will maintain responsibility for the delivery and coordination of client services.

Risks and Benefits of Service

Child and youth mental health services seek to improve the quality of life, behaviour, and emotional well-being of young people. There are however, potential risks involved when choosing whether to participate:

• personal health information and/or personal information of others involved in services (e.g., caregiver, Substitute Decision Maker) that is pertinent to service delivery may be included in the client file, and consequently in requests for access to and/or information from the client file;
• worsening of behaviour, mental health symptoms, and/or functioning; and
• unexpected changes in family dynamics.

Choosing not to participate in services may result in the continuation and/or worsening of behaviour, mental health symptoms, and/or functioning and the child/youth and/or family level.

Service Agreement

I understand that Compass must obtain the consent of the child/youth or Substitute Decision Maker to provide these services. Determination of who will must provide consent is evaluated on an individual basis and considers the age of the child or youth, their capacity to understand the risks and benefits involved, and individual circumstances.

Client’s Rights

All Compass clients have the right:

• to a clear understanding of the services to be delivered and the principles that influence Compass’ delivery of services;
• to confidentiality, to be advised of limits of confidentiality, to consent/withdraw consent to collect, use or disclose personal health information;
• to express their own views freely and safely about matters that affect them;
• to be engaged through an honest and respectful dialogue about how and why decisions affecting them are made and to have their views given due weight, in accordance with their age and maturity;
• to be consulted on the nature of the services provided or to be provided to them, to participate in decisions about the services provided or to be provided to them and to be advised of the decisions made in respect of those services;
• to raise concerns or recommend changes with respect to the services provided without interference or fear of coercion, discrimination or reprisal and to receive a response to their concerns or recommended changes;

• to participate in the development of, and changes to their intervention/treatment plan;
• to be treated with dignity, respect, and without discrimination;
• to a safe and secure service environment;
• to receive services in the official language of their choice;
• to receive services within an Indigenous cultural context and methodology;

• to access the information in their client file;
• to voluntarily participate in Compass’ accreditation process;
• to understand and access a complaint procedure;
• to discontinue or terminate services at any time; and
• any other rights outlined in applicable legislation including the Child, Youth and Family Services Act.

Client’s Responsibilities

My responsibilities as a client are:

• to attend each scheduled session;
• to inform Compass staff as soon as possible if I cannot attend a session;
• to understand that two or more unexplained missed appointments or no contact for 30 days may result in my file being closed; and
• to comply with Compass’ Scent Free policy, for the health of staff and visitors.

Electronic Communications

Electronic communication with Compass staff Includes text messaging, e-mail, video chat or conferencing (via cellular phone or computer) and any other related electronic communications.

• text messages with Compass staff will only be used to confirm, cancel or reschedule appointments;
• electronic communication messages should not include personal health information and may become a part of the clinical record;
• Compass staff will not respond electronically when personal health information is received and will communicate via secured electronic means only;
• Compass staff do not check or respond to electronic communication while in appointments, meetings, outside of office hours, or any other time they are not at work (vacation, illness, etc); and
• in the event of an emergency when unable to reach Compass staff, I will contact Crisis Intervention Program at 705-675-4760 or 1-877-841-1101 or 911.

Having reviewed the Consent to Service with Compass staff, I hereby authorize Compass to deliver mental health service and intervention as described above.