Molloy College
Student Personal Counseling Services
INFORMATION ABOUT CONFIDENTIALITY
AND INFORMED CONSENT
Several federal and state laws, as well as professional ethics, protect the confidentiality of information shared in counseling.* There are a few carefully agreed-upon exceptions to the protection of confidentiality which we believe you should know about prior to beginning counseling. Please review this information carefully and raise any questions you may have with your counselor.
EXCEPTIONS TO CONFIDENTIALITY
1. Student Counseling Center Staff Consultations
In order to assure that counseling progresses as efficiently and effectively as possible, your counselormay consult with other counseling center staff members. These consultations are for professional purposes only and are aimed solely at providingthe best possible care for students. Staff will do as much as possible to conceal identifying information.
2. Other Molloy Staff/Faculty Consultations
You and your counselor may decide that consultation with or referral to other Molloy staff may behelpful. In such cases, information will be shared only with that particular staff member, and only with your permission.
3. Abuse of a Child or Elderly Person
If your counselor has reason to believe that a child under the age of eighteen (18) or an elderly personis being abused or neglected, she/he is obligated to report this situation to the appropriate state agency.
4. Imminent Harm to Self
If your counselor has reason to believe that you are threatening immediate physical harm to yourself and if you are unwilling or unable to follow treatment recommendations, she/he may have to contact afamily member or another person who may be able to help to protect you and/or seek your involuntaryadmission to a hospital or treatment facility.
6. Imminent Harm to Others
If your counselor has reason to believe that you are threatening physical violence against another person, or if you have a history of physically violent behavior and your counselor believes that you are athreat to the safety of another person, she/he may be required to take some action to ensure the other person is protected (such as contacting the police, notifying the other person, seeking involuntary hospitalization, or some combination of these actions).
The situations described above are extremely rare. If, however, they do arise in your counseling, it is our policy that, whenever possible, we will discuss with you any action contemplated as fully as possible. However, you should know that we are not legally obligated to inform you, or seek your permission, especially if such a discussion would prevent us from securing your safety or the safety of others. If disclosure of confidential information does become necessary, we will release only the minimal information necessary to protect you and/or another person.
*Confidential records are kept in locked files and stored on the Student Personal Counseling Service private computer database.
PRIVILEGED COMMUNICATIONS
New YorkState law protects the confidentiality of the relationships between certain mental health professionals and their clients. Communications (verbal or otherwise) made by you to your counselor which are intended as confidential and which occur in the context of counseling are generally considered to be "privileged." Privileged information may not be revealed to third parties without your permission. Exceptions to this general rule of nondisclosure include circumstances in which the StudentCounselingCenter is ordered by a court to release information in the context of child custody, child abuse or criminal proceedings.
RELEASE OF INFORMATION
If you wish any information released about whether or not you were seen at the StudentCounselingCenter or about your actual counseling, you must sign a Consent for Release of Information Form indicating what specific information and to whom (name and address) you wish the information released.
If you have any questions about confidentiality, please bring them to the attention of your counselor or the Director of the Student Counseling Center, Carrie Sollin. The StudentCounselingCenter encourages you to be informed and to help us to maintain a high standard of care through your active participation and knowledge.
EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on August 21, 2008
Molloy College
Student Personal Counseling Services
Consent for Services
Revised: January 2013
I have read and fully understand the above statement on confidentiality.
I understand that Molloy College Personal Counseling Services provides short-term counseling by professional licensed counselors. I may be referred off-campus if I require more intensive or long-term therapy, or if I require resources or competencies beyond what the Student Personal Counseling Service can provide. This includes, but is not limited to, if I am transported to a local hospital for psychiatric assistance.
I understand that if I miss an appointment without notifying the counselor, I will typically be allowed no more than one additional “no show” in one semester before I become ineligible for services. In addition, I will typically be allowed no more than three cancellations per semester. Counselors will notify me of my ineligibility in writing via email, with a copy also placed in my counseling file. Exceptions to this practice might occur, for example, if I become a potential danger to myself or others and am thus in dire need of the services.
I have the right to report any complaint about the Counseling Services to the Director of the Student Counseling Center, Carrie Sollin at (516) 678-5000 ext. 6545 or the Vice President of Student Affairs, Bob Houlihan at (516) 678-5000 ext. 6409.
I have read, understood, and agreed to the foregoing Consent for Services.
Signature of the studentSignature of the counselor
Printed student namePrinted counselor name
Date