Tranquility by GreenShield Health
Coach-Assisted Digital CBT
Informed Consent
PLEASE REVIEW EVERYTHING CAREFULLY, IN PARTICULAR THE DISCLAIMER AND RELEASE SECTIONS BELOW.
TranquilityTM by GreenShield Health (GSH) is an Internet-based Cognitive Behavioural Therapy (Digital CBT) program. Digital CBT is CBT delivered via digital platforms. In Digital CBT, the platform itself is the intervention. Digital CBT provides individuals with skills that can be used to improve their mental health and increase their quality of life.
Tranquility’s Digital CBT program aims to help return you to wellness by providing you with tools and techniques to cope with life’s challenges. CBT is one of the most established and highly effective evidence-based therapeutic models.
COACH & COMMUNICATIONS.
If you choose to use Digital CBT, you will be assigned to a coach. By using the program you hereby consent to being assigned to a coach.
As part of your program, coaches may message clients through a messaging function on the platform. All messaging is for Digital CBT purposes only. By using the program you hereby consent to receiving such messages by your assigned coach.
Confidentiality and Emergency Services.
All calls will be recorded for quality assurance purposes. All of the information you share with your Digital CBT coach/therapist and/or within the platform is strictly confidential and will only be accessible by your coach/therapist and Tranquility’s Clinical and Support staff, except in the following circumstances:
there is a serious and imminent risk of harm to you or another person, which may include situations where there is disclosed use of substances that cause impairment while working in a safety-sensitive position;
there is suspicion that a child (governed under the age of protection in your province) has been or is likely to be harmed, abandoned, abused, neglected, or is otherwise in need of protection;
there is a reason to believe that an older adult or vulnerable person is being or has been abused or neglected and is unable to seek support and assistance due to physical restraint, a physical handicap or an illness, injury, disease or other condition that affects their ability to make decisions about the abuse or neglect;
you have provided to Tranquility your consent, in writing through a signed Release of Information Form, to share with specified others, not already identified in this Informed Consent Form, information concerning your Digital CBT program;
disclosure as required by law; or
your clinician is not able to reach you after you have indicated that you are at serious and imminent risk of harm to yourself. In this case, the clinician will call your emergency contact to determine if you are safe.
In addition, your coach/therapist will disclose information and records to Tranquility’s Clinical Services Team as needed for coordination of services, quality assurance, or payment.
PLEASE NOTE: Tranquility is not an emergency service. If you ever feel you’re in an emergency, please call 911 or go to the nearest emergency room.
Home Address.
Your practitioner will ask for your home address and confirm that you are at that location at the beginning of each call. They will only use this information for emergency purposes (for example if you had a health emergency and they needed to call for help for you).
24 Hour Policy.
If you need to cancel or reschedule, please do so 24 hours before the scheduled call so that we can open that spot up for someone else to get the help they need. If you cancel within less than 24 hours or don't attend your scheduled call, this is considered a "no-show". We have a 3 no-show policy. Other than in extenuating circumstances, your account will be changed from coach- assisted to self-led after 3 no-shows.
Program Plan.
There are 9-12 sessions in this program. We recommend you complete 1 session per week as soon as you can after your sessions with your coach or therapist, so you have the whole week to work on what you’re learning. Your account will be changed to self-led should your coach not hear from you within an appropriate amount of time. PLEASE NOTE: There is no monitoring of your account once you change to self-led Digital CBT.
DISCLAIMERS.
By signing this Informed Consent Form, to the extent permitted by applicable law, you agree that:
NO MONITORING WILL OCCUR DURING SELF-LED DIGITAL CBT OR ONCE YOU ARE NO LONGER MATCHED WITH A COACH, ALTHOUGH YOU MAY CONTINUE TO HAVE ACCESS TO THE PLATFORM. YOU ARE USING THE Digital CBT PLATFORM AT YOUR OWN RISK AS GREENSHIELD HEALTH DOES NOT MONITOR ANY OF YOUR RESPONSES (EVEN IF YOU INDICATE THAT YOU ARE AT RISK OF HARMING YOURSELF OR OTHERS) OR NOTIFICATIONS, AND WILL NOT DISPATCH EMERGENCY AUTHORITIES TO YOUR LOCATION IN THE EVENT OF ANY EMERGENCY. YOU UNDERSTAND THE SCOPE, NATURE AND EXTENT OF THE RISKS INVOLVED IN YOUR USE OF THE DIGITAL CBT PLATFORM AND FREELY AND VOLUNTARILY ACCEPT AND ASSUME ALL SUCH RISKS, AND TAKE FULL RESPONSIBILITY FOR YOUR OWN ACTIONS, SAFETY AND WELFARE;
You will CONTACT APPROPRIATE RESPONSE SERVICES IF YOU ARE EXPERIENCING A LIFE-THREATENING SITUATION, A SAFETY ISSUE AND/OR ANY EMERGENCY;
THERE ARE RISKS TO CONFIDENTIALITY THAT MAY BE CAUSED BY HAVING REMOTE ONLINE VIDEO/PHONE DIGITAL CBT SESSIONS (INCLUDING, WITHOUT LIMITATION: (I) POOR QUALITY AUDIO-VIDEO CONNECTION; (II) DELAYS IN EVALUATION OR TREATMENT DUE TO PRODUCT FAILURE; AND (III) UNAUTHORIZED COLLECTION, USE OR DISCLOSURE OF YOUR PERSONAL INFORMATION DUE TO A SECURITY PROTOCOL BREACH OR FAILURE;
DIGITAL CBT IS NOT TO BE USED FOR EMERGENCIES OR SUICIDAL THOUGHTS OR THOUGHTS OF HARMING OTHERS. TRANQUILITY SHOULD NOT BE USED FOR MEDICAL EMERGENCIES OR IF YOU ARE HAVING SUICIDAL THOUGHTS OR ARE CONTEMPLATING HARMING YOURSELF OR OTHERS.
RELEASE.
EXEMPTION FROM LIABILITY FOR USE. TO THE EXTENT PERMITTED BY APPLICABLE LAW, YOU HEREBY REMISE, RELEASE AND FOREVER DISCHARGE GREENSHIELD, ITS AFFILIATES AND ASSOCIATED COMPANIES, AND ALL THEIR RESPECTIVE AGENTS, OFFICERS, DIRECTORS, SHAREHOLDERS, EMPLOYEES, SUCCESSORS AND ASSIGNS, (COLLECTIVELY, “RELEASED PARTIES”), FROM ALL LIABILITY, ACTIONS, CAUSES OF ACTION, CLAIMS AND DEMANDS OF EVERY NATURE WHICH MAY HAVE BEEN, ARE BEING OR MAY BE MADE OR ASSERTED WITH RESPECT TO, ARISING OUT OF OR IN ANY WAY CONNECTED WITH YOUR ACCESS TO TRANQUILITY. THIS EXEMPTION FROM LIABILITY ALSO INCLUDES LOSS, DAMAGE OR INJURY RESULTING FROM THE NEGLIGENCE OF THE RELEASED PARTIES.
By signing this Informed Consent Form, you acknowledge that you are attending the Digital CBT training program of your own accord and that you understand that you are free to end the program anytime you wish.
By signing this Informed Consent Form, you understand all of the information contained in it and accept it as the terms and conditions of your participation in Tranquility’s Digital CBT program (in addition to the Terms & Conditions, as defined below).
By signing this Informed Consent Form, you understand that these terms are intended to supplement (and are not a replacement for) GreenShield’s terms and conditions (accessible here: INSERT HYPERLINK), which may be replaced or amended from time to time (the “Terms & Conditions”). In the event of a conflict between the terms in this Informed Consent Form and the Terms & Conditions, this Informed Consent Form prevails to the extent of the conflict.
You may revoke your consent at any time with oral and written notice to Tranquility by GreenShield’s Clinical Services Team. If you do not revoke this consent, this consent will expire one (1) year after the date of this authorization.
INDEPENDENT LEGAL ADVICE.
YOU AGREE THAT YOU HAVE READ AND UNDERSTOOD THE CONTENTS OF THIS INFORMED CONSENT FORM (INCLUDING, WITHOUT LIMITATION, THE DISCLAIMERS AND RELEASE). YOU HAVE BEEN GIVEN AN OPPORTUNITY TO OBTAIN INDEPENDENT LEGAL ADVICE CONCERNING THE INTERPRETATION AND EFFECT OF THIS INFORMED CONSENT FORM. IN THE EVENT THAT YOU HAVE CLICKED ‘ACCEPT’ TO THE INFORMED CONSENT FORM WITHOUT THE BENEFIT OF INDEPENDENT LEGAL ADVICE, YOU HEREBY WAIVE THE RIGHT TO RELY ON ANY ARGUMENT THAT YOU DID NOT RECEIVE INDEPENDENT LEGAL ADVICE.
By checking this button, I consent to the information provided above, and will be deemed to have signed this Informed Consent Form.