Play Therapy Service Agreement (NDIS)

In this service agreement (Agreement) “I”, “we” “us” and “our” refer to the Therapist and/or SageAffect (Service Provider) interchangeably. The term “you” and 'your' refers to the Participant and/or Legal Guardian.

This is a mutual agreement negotiated between Laurinda Jones (Therapist) and the Participant before the commencement of Play / Family Therapy. It outlines the support(s) I will provide to you and the terms that those supports will be provided. This includes my responsibilities towards you and also your obligations in the therapeutic relationship.

As a member of the Australian Counselling Association (ACA), I am bound by their Code of Ethics and Practice and the following responsibilities to you, the Client:

1. My Play Therapy services are provided to children who live with a variety of cognitive, social, physical, emotional, behavioural, medical and neurobiological conditions and who believe they would benefit from Play Therapy.
2. I accept both private and government-funded clients.
3. As part of providing a Play Therapy service to you, I will collect and record personal information that is relevant to your current situation. This information will be a necessary part of your child's ongoing treatment.
4. Play Therapy is about helping you and your child access your inner strengths and resources with the realisation that you have the right to determine your own goals for therapy. It is not generally about giving advice, however, I will provide relevant psychoeducation.
5. My approach to Play Therapy underpins a range of integrated therapies including Cognitive Behaviour Therapy (CBT), Narrative Therapy, Gestalt Therapy, Solution Focused Therapy, Person Centred Therapy, Art Therapy, Somatic Therapy, Grief & Trauma Therapy, Synergetic Play Therapy and Filial Play Therapy.
6. Before using any of these therapeutic techniques, I will discuss them with you and will only proceed with a specific modality with your consent.
7. I take my responsibility and your physical, emotional or psychological comfort seriously. I will do everything in my power to prevent any unreasonable risk, harm or injury to you or your child that may arise from your participation in therapy. Please do not partake in any activity if you believe that it will pose a risk to your health and wellbeing.
8. As the client, you have a right to:

• be shown respect for your cultural diversity and sexual orientation
• gain clarity about the goal we will be working toward
• receive an estimate of the number of sessions required to achieve your goal
• receive a clear explanation of the service you will receive
• receive an explanation about the nature and limits of confidentiality
• receive a clear statement about fees
• give your consent before we start therapy
• receive competent and professional service
• be treated with respect and receive a service free from sexual harassment

The following boundaries are set out to create more clarity around expectations for both Therapist and Client and to create a safe context in which therapy can take place.

1. I do not provide emergency counselling services. For emergencies, please dial 000 for police, ambulance or fire services, or contact Kids Help Line on 1800 55 1800.
2. In between sessions, you may contact me via phone, email or text messaging during business hours only (Monday to Thursday from 8am - 6pm). I will respond as soon as I have a gap in between clients or at the end of the business day.
3. During the contractual stage of therapy, any dual relationship such as establishing a business relationship, or becoming friends on Facebook, etc. will be avoided to prevent any risk of harm to our professional relationship.
4. While it is very natural for children to want to hug or touch, I will manage touch in a considered way to avoid misunderstandings, particularly for those clients who may have experienced relational trauma.

1. The first, 90-minute intake session will allow me to explain the therapeutic process and gather enough information from you, the parent/guardian, about your child and family situation. All sessions thereafter will be with your child only, unless we have agreed to do Filial / Family Therapy.
2. Play Therapy sessions for children are one hour in duration and, depending on your individual plan, may occur weekly or fortnightly. Occasionally, sessions may go over time and will be billed accordingly.
3. After the third session, once I have gathered enough information, I will create a therapy plan that reflects your values, believes, needs and budget. As a unique client with your own therapeutic goals, the number of sessions you will need depends on your individual requirements.
4. Throughout the course of our therapeutic relationship, you will have the opportunity to review your goals and therapy plan. It is my responsibility to ensure that, at all times, you have free choice in deciding whether or not you want to continue with therapy.

1. I deliver therapeutic supports to NDIS Plan-Managed and Self-Managed participants as an unregistered provider under the following Australian Business Number (ABN): 49 688 045 484.
2. During the initial intake session, I will gather information about your NDIS Plan goals, dates and your use of other services to determine how many hours to allocate to Play Therapy.
3. As an NDIS participant, you will be billed in line with the NDIS item: Early Childhood Supports (0-7) or Therapy Supports (7+) - Counsellor at $156.16 per hour. Therefore, the initial 90-minute intake session is billed at $234.24 and each 60-minute session thereafter is billed at $156.16
4. Any additional non-face-to-face activities such as therapy planning, NDIS requested report writing, liaising with other professionals via phone calls, case meetings, and developing resources, etc. will be billed prorata based on the same hourly rate of $156.16, e.g. 15-minute phone call to the teacher will be billed at $39.04.
5. Travel costs for mobile services are billed as per the NDIS guidelines. The maximum amount of travel time I will claim at each visit is 30 minutes. The same hourly rate of $156.16 will be used to calculate the claimable travel cost, e.g. 25 minute travel time will be charged at $66.
6. Plan Managed Participants: invoices will be sent directly to your plan manager within 48 hours of service delivery. Payments are due within 14 days.
7. Self Managed Participants: I will invoice you directly within 48 hours of service delivery. Payments are due within 7 days.
8. Late payments and outstanding bills may result in a suspension of services until all fees are paid in full. Where necessary, I may use the service of a debt collection agency to recover the debt. I will provide them with your contact details so they can recover the outstanding sums.

1. If, for some reason, you need to cancel or reschedule an appointment, please provide a minimum of 24 hours notice. Any cancellation of sessions with less than 24 hours notice will incur a full fee.
2. In the event of my own illness or an emergency, I will give you as much notice as possible and offer you an alternative time.
3. Please note that sessions will be cancelled if you are under the influence of alcohol or other illegal drugs. This cancellation will incur a full fee.

1. Confidentiality is an essential aspect of the counselling relationship. Everything that is discussed in our session together is kept in the strictest confidence.
2. I usually keep brief notes about each session which are securely stored in a locked filing system or on an online database. Upon written request, you may view any information I have kept about your therapy sessions. Please allow up to 48 hours for this information to be made available to you.
3. Occasionally I may want to make an audio or video recording of our session together to monitor my work as a therapist. This would only occur with your prior knowledge and permission. This data will be safely disposed of after use.
4. As a registered member of the ACA, I am required to have regular supervision. I may need to discuss our therapy sessions with a supervisor. If so, I will not disclose your name or anything that would enable you to be identified during these discussions.
5. In certain circumstances, I may have to make exceptions to the general rules of confidentiality:

• if there is convincing evidence that you or your child intend to harm yourself, I might need to inform your referring doctor or your emergency contact,
• if you disclose that your actions may pose a risk to children or others (this may fall under mandatory reporting requirements which I am bound by law to report),
• where there is a legal requirement or if I am ordered by a court of law to disclose information,
• when you have given me approval to provide a written report, or to discuss information with relevant professionals, e.g. your referring GP, other health care professionals or your employer.

1. It is my responsibility to work with you to reach a recognised ending when it is evident that you and your child have achieved your therapeutic goals. You may wish to cease your sessions with me when it is apparent that play therapy is no longer helping or when you decide to end.
2. Should I be unable to support your specific needs, I may need to refer you to another professional with more expertise. At all times, I will discuss this with you to prevent any potential risk of emotional or psychological harm.
3. For any complaints about me or the service I offer, please contact the Australian Counselling Association.
4. For any NDIS related complaints, please contact the NDIS Quality and Safeguards Commission on 1800 035 544.