Definition of Mindfulness Based Ecotherapy
Mindfulness-Based Ecotherapy (MBE) is a blending of Mindfulness and Ecopsychology. MBE uses nature to facilitate mindful awareness. MBE is used as a framework for helping individuals to find deeper connections in their own lives, and to give more meaning and enjoyment to the activities of daily living.
Consent to Ecotherapy Services
I consent to receive Ecotherapy services provided by Wellness Grove. I understand that these services may include a pre-screening process and may include documentation related to my group experience that is deemed necessary by my group facilitator’s professional judgment.
I understand that I am responsible for any personal items that I choose to take to Ecotherapy groups and that the facilitator(s) and Wellness Grove are not held liable for any lost and/or stolen items.
I understand that I am responsible for my own safety during any and all experiences and/or interactions with Ecotherapy groups and that the facilitator(s) and Wellness Grove are not held liable for any injuries or bodily harm that could occur during the group or services being received and/or rendered.
I understand that:
- For Ecotherapy groups to be most effective, it is important for me to take an active role in the process to include arriving to group sessions on time, being honest with my facilitator(s) and group members, and maintaining ownership of mutually agreed upon goals.
- Ecotherapy groups are a confidential space in which group members may be invited to share their thoughts and feelings related to the content being presented. I understand that it is my choice to share what I am comfortable with sharing.
- All confidentiality protections required by law or regulation will apply to my group experience.
- Ecotherapy information will be communicated to me by the group facilitator(s) to include, but not limited to; frequency of group sessions, number of group sessions, environment that group will take place in, group goals, and group rules.
- I am encouraged to disclose potential health concerns that could affect my ability to participate in Ecotherapy groups to the facilitator(s) during the first session. Potential health concerns could include allergies, heart problems, mobility concerns, etc. I am encouraged to bring my own medication or tools to manage any potential concerns.
- Ecotherapy groups will consist of practicing mindfulness skills in a nature setting. The facilitator(s) will present exercises that may include some walking on uneven terrain in nature. The facilitator(s) will not present skills that involve long distance walking, getting in water, or intense movements. I understand that it is my choice to participate in activities that involve movement or walking and that I may decline to participate at any time.
- I am encouraged to regularly discuss progress and review goals with my facilitator(s) and group members, and to address any concerns or questions regarding progress and goals should they arise.
- I have the right to refuse, or discontinue, Ecotherapy services at any time without the decision impacting my right to future care or treatment, and without risking any service benefits to which I would otherwise be entitled.
- I will have access to all information resulting from Ecotherapy services as provided by law, and that my express permission is required before my medical information may be shared with a third-party, unless otherwise allowed by law.
- No staff member or group facilitator will discriminate against clients on the basis of race, religion, age, sex, sexual orientation, gender identity, ethnicity, physical or mental impairment, financial or social status.
- I have the right to be treated with the upmost respect and courtesy by all Wellness Grove staff members and my group facilitator(s).
Benefits of Ecotherapy
I understand that Ecotherapy has numerous benefits. I understand and acknowledge that for many group members, the outcomes of Ecotherapy are positive and can include, but are not limited to; a greater understanding of self, learning mindfulness and emotional regulation strategies, a reduction of mental health symptoms, increased feelings of connectedness with the world, greater quality of life, and increased happiness and life satisfaction.
Risks of Ecotherapy
I understand that there are potential risks with any form of group counseling including Ecotherapy. I understand that potential risks associated with participation in Ecotherapy groups can include, but are not limited to: experiencing increased stress or uncomfortable emotions (such as sadness, guilt, anxiety, frustration), relational difficulties, and no change or an increase in problematic symptoms/experiences despite efforts from myself, the facilitator(s), and/or members of the group.
Due to being out in nature, some other risks of Ecotherapy services include being seen by people who are at the park for leisure activities and injuries related to being in nature, including but not limited to: bug bites, sunburn, allergic reactions, and other bodily injuries.
I understand that should any of these risks occur, I will discuss my experienced concerns, discomfort, behavior changes, or questions with my group facilitator(s) who may be able to help me better understand my experience and/or find different solutions to my problems that may be more satisfying. I understand that when appropriate my group facilitator(s) may desire to coordinate care with another provider or entity, but only with my written consent. I understand that if my clinical needs exceed the scope of services offered by Wellness Grove, I will be offered appropriate referrals.
Confidentiality
I acknowledge and understand that discussions within the group setting are confidential. I understand that no information concerning my group experience will be released without written consent unless mandated by law. I understand that possible exceptions to confidentiality include, but are not limited to the following situations: danger of harming myself or others, child abuse, elder abuse, animal abuse, criminal prosecutions, suits in which the mental health of a party is in issue, and the filing of a complaint with a licensing board or other state or federal regulatory authority. I also understand that my group facilitator(s) may disclose my confidential information to any other person or entity of my choice upon receipt of a valid and executed release of information from me. I also understand that if I am using insurance for group counseling services, Wellness Grove is required to communicate information about my treatment to my carrier such as, but not limited to, my clinical diagnosis for the purposes of reimbursement. I also understand that group counseling is effective because individuals feel safe sharing personal and private information in a confidential setting. It is important that every member of the group uphold the confidentiality of other group members. My group facilitator(s) will discuss a group or individuals in the group only with professionals at Wellness Grove for supervision or consultation purposes only.
Confidentiality policy for minors (for clients under 18 years of age)
I acknowledge and understand that parent(s)/guardian(s)/legal representative(s) have a legal right to examine a minor’s counseling records should these be kept as part of the group experience. However, in order for many minor clients to feel comfortable in group counseling, it is beneficial for them to talk within the group setting about the group counseling process and to know that what they tell the group will be kept private/confidential except in cases of imminent danger to themselves or others, or in instances when the group facilitator(s) considers the information to be so serious that the parents’/guardians’/legal representatives’ be kept informed to promote the client’s welfare.
By signing this agreement, you are agreeing to this informal waiver of your right to full disclosure of the minor’s records. If you choose not to informally waive this right, please talk with the group facilitator(s) about your concerns prior to signing this form.
Group Facilitator Incapacity or Death
I understand and acknowledge that in the event that my facilitator(s) becomes incapacitated or dies, it will become necessary for another facilitator to take procession of my records, if kept for the group experience, and provide continued services. I understand that I have the right to seek group or individual counseling services elsewhere, and if I should choose to do so my records will be communicated once I complete and sign a release of information.
Group Counseling Records
I understand that my group counseling sessions shall not be audio/video recorded in any way unless agreed to in writing by mutual consent. I understand that my facilitator(s) will maintain a record of the sessions using a HIPAA-compliant electronic health records system should I be attending for clinical reasons. I understand that correspondence via email will also be through a HIPAA-compliant email service.
I understand that upon written request I may review my counseling records. I acknowledge and understand that in order to ensure the information in my records is clearly understood, I will be asked to schedule an appointment with my facilitator(s) or another member of the counseling staff to review the information.
For Parents/Guardians/Legal Representatives of Minor Clients Attending Group Counseling for Clinical Purposes
If the client is under 18 years old, I understand that Wellness Grove will need to have a copy of court documents or custody papers that prove I am a legal guardian. I understand that if there is a shared parenting agreement in my custody agreement, Wellness Grove will need a copy of this paperwork demonstrating my right to make decisions concerning my child’s mental health treatment. I understand that if I am in a co-parenting arrangement, it is most beneficial for both parents to be involved in my child’s treatment in some capacity. I understand that decisions will always be based upon what is in the best interest for my child.
Wellness Grove Review & Grievance Reporting
I understand that Wellness Grove will periodically send out electronic review requests to the primary email address on file in order to gain feedback for the continual improvement of quality group counseling care. I understand that these requests are optional and should I opt-in to provide a review, my responses will be reviewed by Wellness Grove management and kept confidential.
I acknowledge and understand that I have the right to file a grievance at any time with Wellness Grove should I ever have any issues in my interactions with any Wellness Grove staff member or group facilitator. I further understand that my grievance will be reviewed by management and taken seriously, that my grievance will be investigated fully, and that reporting a grievance will not result in retribution or impact my continuation of care at Wellness Grove.
Termination of Group Counseling Services
I understand that ending group therapy prematurely should not be done casually, although either my group facilitator(s) or I may decide to end group counseling if either of us believes it is in my best interest. I understand that should I wish to stop group counseling at any time, I am encouraged to meet for at least one additional session to discuss my decision with the group, and to receive any recommendations/referrals that my group facilitator(s) believes are important to my well-being.