CLIENT RIGHTS 

TABLE OF CONTENTS

Your Rights

Grievance Filing

Minors/Parents/Guardians

Mutual Rights and Responsibilities

The Ohio Department of Mental Health and Addiction Services (OMHAS) Client Rights and Grievance Procedure Administrative Rule 5122-26-18 requires that as a client of Mid-Ohio Psychological Services, Inc., you must be informed of client rights.  Therefore, it is necessary that you read the following and show your recognition of these rights by signing.  Please feel free to ask questions if you have any doubts about any right or the meaning. 

YOUR RIGHTS

While you are receiving services at Mid-Ohio Psychological Services, Inc. you have the following rights: 

1. The right to be treated with consideration and respect for personal dignity, autonomy, and privacy. 
2. The right to reasonable protection from physical, sexual or emotional abuse and inhumane treatment. 
3. The right to receive services in the least restrictive, feasible environment defined in the treatment plan. 
4. The right to participate in any appropriate and available service that is consistent with an individual service plan (ISP), regardless of the refusal of any other service, unless that service is a necessity for clear treatment reasons and requires the client’s participation. 
5. The right to give informed consent to refuse any service, treatment or therapy, including medication absent an emergency.  A full explanation of the expected consequences of such consent or refusal. A parent or legal guardian may consent to or refuse any service, treatment, or therapy on behalf of a minor client. 
6. The right to active and informed participation in the development, review and revision of one’s own individualized treatment plan and receive a copy of it.  The right to a current, written, individualized service plan that addresses one’s own mental health, physical health, social and economic needs, and that specifies the provision of appropriate and adequate services, as available, either directly or by referral. 
7. The right to freedom from unnecessary or excessive medication, and to be free from restraint or seclusion unless there is immediate risk of physical harm to self or others. 
8. The right to be informed and the right to refuse any unusual or hazardous treatment procedures. 
9. The right to freedom from abuse, financial or other exploitation, retaliation, humiliation, and neglect. 
10. The right to be advised and the right to refuse observation by others and by techniques such as one-way vision mirrors, tape recorders, video recorders, television, movies, photographs or other audio and visual technology. This right does not prohibit an agency from using closed-circuit monitoring to observe seclusion rooms or common areas, which does not include bathrooms. 
11. The right to confidentiality of communications and personal identifying information within the limitations and requirements for disclosure of client information under state and federal laws and regulations. 
12. The right to have access to one’s own client record unless access to certain information is restricted for clear treatment reasons. If access is restricted, the treatment plan will include the reason for the restriction, a goal to remove the restriction, and the treatment being offered to remove the restriction.  “Clear Treatment Reasons” will be understood to mean only severe emotional damage to the client such that dangerous or self-injurious behavior is an eminent risk. The person restricting the information will explain to the client and other persons authorized by the client the factual information about the individual client that necessitates restriction. The restriction must be renewed at least annually to retain validity. Any person authorized by the client has unrestricted access to all information. Client will be informed in writing of agency policies and procedures for viewing or obtaining copies of records. 
13. The right to be informed a reasonable amount of time in advance of the reason for terminating participation in a service, and to be provided a referral, unless the service is unavailable or not necessary. 
14. The right to be informed of the reason for denial of a service. 
15. The right not to be discriminated against for receiving services on the basis of race, ethnicity, age, color, religion, gender, national origin, sexual orientation, physical or mental handicap, developmental disability, genetic information, human immunodeficiency virus status, inability to pay or in any manner prohibited by local, state or federal laws. 
16. The right to know the cost of services. 
17. The right to be verbally informed of all client rights, and to receive a written copy upon request. 
18. The right to exercise one’s own rights without reprisal, except that no right extends so far as to supersede health and safety considerations. 
19. The right to file a grievance. 
20. The right to have oral and written instructions concerning the procedure for filing a grievance, and to assistance in filing a grievance if requested. 
21. The right to be informed of one’s own condition. 
22. The right to consult with an independent treatment specialist or legal counsel at one’s own expense. 

GRIEVANCE FILING

If you have  questions concerning these rights or would like to file a grievance, you may contact the Client Rights Officer, Shawna Watts (Mid-Ohio Psychological Services, Inc., 106 Starret Street #100, Lancaster, Ohio 43130) during normal working hours (9:00 am to 4:00 pm) or by calling (740) 687-0042.  The Client Rights Officer is responsible for accepting and overseeing the grievance process of  grievances filed by a client or other person or agency on behalf of a client.  If the Client Rights Officer is the subject of the grievance or is unavailable, the alternative Client Rights Officer is Sherry Knox and can be contacted as noted above. 

Mid-Ohio Psychological Services is an agency which receives funds from and is licensed by the Ohio Mental Health and Addiction Services and nationally accredited by CARF.  The agency is contracted with the Fairfield County ADAMH Board and receives funds from each of the county boards it operates clinics in and as such is subject to audits by these entities.  All information obtained in audits will be maintained as confidential as required by state and federal confidentiality regulations. 

You may also seek additional help by contacting any of the following agencies. 

1. Fairfield County ADAMH Board (Fairfield County Residents)
   108 W. Main Street, Suite A
   Lancaster, Ohio 43130
   (740) 654-0829 Fax (740) 654-7621 

1. Franklin County ADAMH Board (Franklin County Residents)
   447 East Broad Street
   Columbus, Ohio 43215
   (614) 224-1057 Fax (614) 224-0991 

1. Mental Health and Recovery for Licking and Knox Counties (Licking County Residents)
   1435-B West Main Street
   Newark, Ohio 43055
   (740) 522-1234 Fax (740) 522-3502 

1. Delaware-Morrow MHRS Board (Delaware County Residents)
   40 North Sandusky Street, Suite 301
   Delaware, Ohio 43015
   (740) 368-1740 Fax (740) 368-1744 

1. Ohio Department of Mental Health & Addiction Services
     Consumer Advocacy & Protection Specialist
   30 East Broad Street, 8th Floor
   Columbus, Ohio 43266-0414
   (877) 275-6364 Fax (614) 466-1571 

1. State of Ohio Psychology Board
   77 South High Street, Suite 1830
   Columbus, Ohio 43215-6108
   (614) 466-8808 Fax (614) 728-7081
   (877) 779-7446 Toll Free 

1. Ohio’s Client Assistance Program  

Disability Rights Ohio
200 Civic Center Drive, Suite 300
Columbus, OH 43215 (614) 466-7264 Fax: 614-644-1888
(800) 282-9181 Toll Free 

1. State of Ohio Counselor and Social Worker and Marriage and Family Therapist Board
   77 South High Street, 24th Floor, Room 2468
   Columbus, Ohio 43215-5919
   (614) 466-0912 Fax (614) 728-7790 

1. Regional Manager
   Office for Civil Rights
   U.S. Department of Health & Human Services
   233 N. Michigan Ave., Suite 240
   Chicago, Illinois 60601
   Customer Response Center: (800) 368-1019
   Fax: (202) 619-3818
   TDD: (800) 537-7697
   Email: [email protected]  

1. State Medical Board of Ohio
   30 East Broad Street, 3rd Floor
   Columbus, Ohio 43215-6127
   (614) 466-3934 Fax (614) 728-5946
   (800) 554-7717 Toll Free 

Email: [email protected] 

1. Attorney General’s Office
   Health Care Fraud Unit
     150 E. Gay Street, 17 Floor
   Columbus, Ohio 43215
   (614) 466-0722 Fax (614) 644-9973 

1. Nursing Education & Nurse Registration Board
   17 South High Street, Suite 660
   Columbus, Ohio 43215-3466
   (614) 466-3947 Fax(614) 995-3685 

Email:  [email protected] 

MINORS/ PARENTS/GUARDIANS

While privacy in mental health treatment is often crucial to successful progress, particularly with teenagers, parental involvement is also essential to successful treatment.  For minors 14 and over, it is our policy to request an agreement between the client and their parents allowing us to share general information about the progress of the child’s treatment and their attendance at scheduled sessions.  We will also provide parents with a summary of their child’s treatment when it is complete.  Before giving parents information, we will discuss the matter with the child, if possible, and do our best to handle  objections they may have.  Clients under 14 years of age who are not emancipated, and their parents should be aware that the law allows parents to examine their child’s treatment unless otherwise prohibited by court order, statute, or rule.  Minors between 14 and 18 may independently consent to and receive up to 6 sessions of psychotherapy (provided within a 30-day period) and no information about those sessions can be disclosed to anyone without the child’s agreement; however, parents may be able to access their records if they discover that the child received services. Parents who have legal authority of their child have a right to inspect their minor children’s files. 

I hereby give consent to Mid-Ohio Psychological Services, Inc. to provide mental health treatment services to my minor child, including the diagnosis and treatment of a gender related condition, including gender dysphoria.  Such treatment may include individual counseling, group counseling, crisis intervention, referral assistance or consultation depending on my minor child’s particular needs or presenting concerns. 

It is this agency’s policy to attempt to engage both parental figures in their child’s treatment unless parental rights have been terminated through court order.  Additionally, both parents may have access to view and/or request copies of the child’s treatment record.  If parental rights have been terminated, it is the responsibility of the parent who is seeking treatment for the child to provide documentation reflecting termination of parental rights.   

In some instances, parental rights have been revoked and another person or agency is given legal authority for a child.  In other cases, an adult is assigned a guardian by the court when the adult is unable to make decisions for themselves.  In all cases where guardianship has been assigned, the guardian must present court documentation clarifying this guardianship relationship prior to the provision of services.  If guardianship changes during involvement with our agency, it is the responsibility of the guardian to notify our staff of this change by providing updated documentation by the court of this change. 

MUTUAL RIGHTS AND RESPONSIBILITIES

Your clinician is responsible for using your treatment time wisely and for developing and following a treatment plan that will help you deal with your problems.  If your clinician believes that a problem would best be handled by another health care provider–a counselor, psychologist, specialists, or physician–a referral will be made.  Your clinician will use available resources to help you. 

You are responsible for cooperating with treatment and for trying to change those things that you and your clinician have identified to be changed.  That means you must work on your problems both in sessions and in daily life.  You always have the right to ask for a change in treatment or to refuse treatment unless you are under court order.  If you believe you are not being helped, please tell your clinician so that changes can be made if possible.  If you continue to feel you are not being helped, we will help you find another service provider. 

Whenever you change your behavior, there are certain risks involved such as interpersonal strain, family conflicts, etc.  Your clinician will make every effort to clarify these risks when they come up.  When you enter a counseling/psychotherapeutic relationship, you are almost certain to change your perceptions of the world and the way you interact with the people you encounter daily.  These changes may result in emotional/interpersonal/economic difficulties, and this is always a risk in participating in treatment.  Sometimes, situations must get worse before they can get better.  During diagnostic assessment, you may discover parts of yourself that you are uncomfortable with and may have to admit to behaviors that embarrass you.  Sometimes, this results in a drop in self-esteem and may make you feel worse.  If you are participating in forensic services (court ordered services), you may deal with additional legal repercussions as the result of your participation in services provided by this agency.  Your clinician will review with you the possible consequences of each intervention strategy.  You have a right to refuse treatment at any time.