AFTC Service Agreement This field is hidden when viewing the formGUIDThis field is hidden when viewing the formreqCodeThis field is hidden when viewing the formuserEmail This field is hidden when viewing the formSubmission Date (Admin Only) DD slash MM slash YYYY The Newcomer Collaborative Community Mental Health Service is a unique model that brings together the expertise and services of Aurora Family Therapy Centre, Family Dynamics, Manitoba Adolescent Treatment Centre (MATC), WRHA - Clinical Health Psychology, and WRHA – Community Mental Health in an inter-disciplinary team that addresses the needs of newcomers with moderate to severe trauma/PTSD. The intended function of the program is to provide early screening, identification, and treatment of mental health problems through trauma-informed clinical treatment (therapy), access to psychiatry and psychology services and whenever possible, incorporates cultural healing. This is a voluntary service and you can decline to participate at any time. The following policies guide our work: Confidentiality: Aurora will keep the information you give us confidential unless you give us permission to share it and/or we are required by law to do otherwise. By law, we must and will report to the appropriate authorities any evidence of sexual, physical, emotional abuse and/or neglect of a child or vulnerable person. We are also professionally required to report to the appropriate person(s) when we believe that the life of a client or someone else is in immediate danger. Collection of Personal Information: The collection of personal information is limited to only that which is necessary to carry out the services and supports. Aurora implements all reasonable security measures to protect personal information at all times. Clients have the right to access their information upon request. When a therapist has reasonable grounds to believe that there has been a breach of client privacy, including loss, theft, unauthorized access or disclosure, the breach is reported immediately to the Executive Director. Consultation: Therapists at Aurora regularly consult with their colleagues and a clinical supervisor as a way of providing you with the best possible service. We only share the least amount of information that is necessary. If there is someone here you do not want your therapist to consult with, please let your therapist know. Missed Appointments: We understand that sometimes things come up that prevent you from attending your scheduled appointments. If you are unable to attend an appointment, please let your therapist and/or interpreter know as soon as possible. CARMIS: We make use of a secure, web-based practice management system to store and manage our client records. This includes information such as client appointments, session notes, contact details, and other client-related information and documents. The system we use is encrypted, has servers exclusively located in Canada and access to the system is granted only on an as-needed basis and governed by our strict confidentiality policy. Additionally, all practice data in the system is routinely backed up to ensure the privacy and protection of sensitive client information and to assist us with PHIPA compliance. Length of Therapy: This program is designed to provide long-term support. Your therapist will talk with you about your goals and usually, your therapist and you will mutually decide when therapy ends. What to do in a crisis: Aurora therapists are not always available on a drop-in basis and/or immediate basis. If you are experiencing a crisis, please use Klinic’s 24/7 Crisis Line (204) 786-8686, call the Mobile Crisis Line (204) 940-1781 or go to the Crisis Response Centre at 817 Bannatyne Avenue (open 24 hours a day/7 days a week). "By signing below, I confirm that I understand and agree to the Newcomer Collaborative Community Mental Health Service terms and conditions outlined on this form."(Your therapist will review these at your first session. You can wait to sign it until that time if you wish.) Date Signed(Required) DD slash MM slash YYYY Full Name(Required)Signature(Required)