Informed Consent for Telepsychology Some or all of your child’s evaluation may take place via telepsychology. The use of telepsychology will vary from one evaluation to another, based on the needs of the child, the purpose of evaluation, and technological variables. Your clinician will discuss the use of telepsychology (including technical and environmental requirements) with you prior to the beginning of your child’s evaluation. This Informed Consent for Telepsychology contains important information focusing on doing telepsychology using the phone or the Internet. Benefits and Risks of Telepsychology Telepsychology refers to providing psychotherapy or assessment-based services remotely using telecommunications technologies, such as video conferencing or telephone. One of the benefits of telepsychology is that the client and clinician can engage in services without being in the same physical location. Telepsychology, however, requires technical competence on both our parts to be helpful. Although there are benefits of telepsychology, there are some differences between in-person psychology and telepsychology, as well as some risks. For example: Risks to confidentiality. Because telepsychology sessions take place outside of our office, there is potential for other people to overhear sessions if you are not in a private place during the session. On our end, we will take reasonable steps to ensure your privacy. But it is important for you to make sure you find a private place for our session where you will not be interrupted. It is also important for you to protect the privacy of our session on your cell phone or other devices. You should participate in telepsychology only while in a room or area where other people are not present and cannot overhear the conversation. Issues related to technology. There are many ways that technology issues might impact telepsychology. For example, technology may stop working during a session, other people might be able to get access to our private conversation, or stored data could be accessed by unauthorized people or companies. Efficacy. Most research shows that telepsychology is about as effective as in-person psychological services. However, some clinicians believe that something is lost by not being in the same room. For example, there is a debate about a clinician’s ability to fully understand non-verbal information when working remotely. Testing. Most psychological, neuropsychological, and educational tests have been developed and standardized for in-person use. Research on remote application is ongoing, but at present varies from one instrument to another. Your child’s clinician will make every effort to use remote testing in the most valid and reliable manner possible, however, in some cases, this represents a departure from test standardization and may impact conclusions derived from those tests as well as the use of these tests in educational or legal settings. You should discuss the specifics of your child’s battery with your clinician. Confidentiality We have a legal and ethical responsibility to make our best efforts to protect all communications that are a part of our telepsychology. However, the nature of electronic communications technologies is such that we cannot guarantee that our communications will be kept confidential or that other people may not gain access to our communications. We will try to use updated encryption methods, firewalls, and back-up systems to help keep your information private and will not record any telepsychology sessions without previous written consent; however, there is a risk that our electronic communications may be compromised, unsecured, or accessed by others. You should also take reasonable steps to ensure the security of our communications (for example, only using secure networks for telepsychology sessions and having passwords to protect the device you use for telepsychology). The extent of confidentiality and the exceptions to confidentiality that we outlined in our Informed Consent still apply in telepsychology. Please let us know if you have any questions about exceptions to confidentiality. Please note: test materials are copywritten by test publishers, and it is expressly forbidden for you or your child to save, print, record, photograph, or otherwise preserve materials used in tele-assessment. Informed Consent This agreement is intended as a supplement to the general informed consent that we agreed to at the outset of our clinical work together and does not amend any of the terms of that agreement. Your signature below indicates agreement with its terms and conditions. Signature:* Name:* Date:* , Choose Clinician:* Dr. MoldoverDr. HebertDr. Benetti-McQuoid Intake Forms Menu Client Intake Form Consent and Agreement for Psychological Testing and Evaluation Notice of Privacy Practices Financial Policies and Statement Informed Consent for Telepsychology Child Custody Declaration We invite you to view our list of upcoming events and to listen to one of our past events. Our Events Parent Guide to Assessment Your Child’s Assessment and DiagnosisA Guide for Parents Read the Parent Guide New PatientIntake Packet Forms to be filled out in advanceof your upcoming appointment View Our Intake Packet Clinicians Meet Our Team