Awakening Hope, LLC
DISCLOSURE STATEMENT
1. INFORMATION:
Diana Chavez, LPC
Awakening Hope, LLC
720.507.8011
2. CREDENTIALS:
Licensure: Licensed Clinical Counselor, License # LPC. 0012882
EMDR Certified
Degrees:
Master of Arts, University of Northern Colorado, Clinical Counseling
Bachelor of Science, Metropolitan State University, Human Services
3. REGULATION OF PSYCHOTHERAPISTS
The practice of licensed or registered persons in the field of psychotherapy is regulated by the Mental Health Licensing Section of the Division of Registrations. The Board of Registered Psychotherapists can be reached at 1560 Broadway, Suite 1350, Denver, Colorado 80202, (303) 894-7800.
Levels of regulation of mental health professionals in Colorado include licensing (requires minimum education, experience, and examination qualifications), certification (requires minimum training, experience, and/or education levels, examination qualifications), and registration (does not require minimum education, experience, or training). All levels of regulation require passing a jurisprudence take-home examination.
A Licensed Clinical Social Worker, a Licensed Marriage and Family Therapist, and a Licensed Professional Counselor must hold a master’s degree in their profession and have two years of post-master’s supervision. A Licensed Psychologist must hold a doctorate degree in psychology and have one year of post-doctorate supervision. A Licensed Social Worker must hold a master’s degree in social work. A Psychologist Candidate, a Marriage and Family Therapist Candidate, and a Licensed Professional Counselor Candidate must hold the necessary licensing degree and be in the process of completing the required supervision for licensure. A Certified Addiction Counselor I (CAC I) must be a high school graduate and complete required training hours and 1,000 hours of supervised experience. A CAC II must complete additional required training hours and 2,000 hours of supervised experience. A CAC III must have a bachelor’s degree in behavioral health, and complete additional required training hours and 2,000 hours of supervised experience. A Licensed Addiction Counselor must have a clinical master’s degree and meet the CAC III requirements. A Registered Psychotherapist is registered with the State Board of Registered Psychotherapists, is not licensed or certified, and no degree, training or experience is required.
4. SERVICES ARE PROVIDED IN ACCORDANCE WITH THE FOLLOWING GUIDELINES:
You are entitled to receive information from me about my methods of therapy, the techniques I use, and the duration of your therapy.
You can seek a second opinion from another therapist or terminate therapy at any time.
In a professional relationship (such as ours), sexual intimacy between a therapist and client is never appropriate and is illegal in Colorado.
If sexual intimacy occurs, it should be reported to the Department of Regulatory Agencies.
Generally speaking, information provided by and to a client in a professional relationship with a psychotherapist is legally confidential, and the therapist cannot disclose the information without the client’s consent; pursuant to Colorado Revised Statutes (CRS) § 27-10-101 et.seq. & Standard C.F. et.seq. There are several exceptions to confidentiality some of which are listed in CRS § 12-43-218 and in the Notice of Privacy Rights that you were provided. These include: (1) I am required to report any suspected incident of child abuse or neglect to law enforcement; (2) I am required to report a threat of imminent physical harm to self or others to law enforcement and to the person(s) threatened; (3) I am required to initiate a mental health evaluation of a client who is imminently dangerous to self or to others, or who is gravely disabled, as a result of a mental disorder; (4) I am required to report suspected abuse, caretaker neglect, and exploitation of at-risk elders. All therapists are required by law to report such instances to the Department of Social Services.
Under Colorado Law, C.R.S. § 14-10-123.8, parents have the right to access mental health treatment information concerning their minor children, unless the court has restricted access to such information. If you request treatment information from me, I may provide you with a treatment summary, in compliance with Colorado law and HIPPA standards. In the case of shared custody between parents, it is the parent seeking therapy for the child’s responsibility to keep the other parent informed about psychotherapy. If it is indicated, the other parent may be required to be involved in therapy and may also be asked to sign a consent form for treatment. It may be necessary for you to assist and encourage the involvement of the other parent.
I have read the preceding information, it has also been provided verbally, and I understand my rights as a client or as the client’s responsible party.