EMU Psychology Clinic
Client Information Statement
Description of Services
The EMU Psychology Clinic is a not-for-profit training facility for the Clinical Psychology area in the Department of
Psychology at Eastern Michigan University. The services of the Clinic are provided by graduate students who are
completing advanced training under the supervision of the Clinical Psychology Faculty. The three main functions of the
Clinic are: (a) to offer psychological services to the Ypsilanti community and surrounding region, (b) to provide
professional training for Clinical Psychology graduate students, and (c) to support clinically relevant research projects.
The Clinic’s office hours are 8:30 AM–7:00 PM Monday through Thursday, and 8:30–4:00 pm on Friday. The Clinic
operates on a 12-month basis, although services may be significantly curtailed during breaks between semesters.
The Clinic Director, Karen Saules, Ph.D., oversees the management of the Clinic under the authority of the Department
Head and in close consultation with the Clinical Training Director and the Clinical Area Faculty. Questions or comments
about Clinic services should first be directed to the Clinic Administrative Assistant, Ms. Alicia Bake, or, if possible, the
client’s Therapist. Should further information be required, clients may contact the Therapist’s Faculty Supervisor and/or
the Clinic Director.
Supervision
All services provided through the Clinic are conducted under the direct supervision of the Clinical Psychology faculty. Each
Therapist is assigned to a specific Faculty Supervisor, who meets regularly with the Therapist to discuss his/her client
caseload. Discussion of clients may occur between Therapist and Supervisor alone or in small groups of students for
whom the Supervisor also has responsibility. In addition, with the client’s approval, supervisors may use direct
observations, and/or video recording to provide appropriate supervision of Therapists’ activities. Other student trainees
may also be involved in this supervisory process, and they are held to the same high standards of confidentiality
protections as are the Therapist and Supervisor. Faculty Supervisors are licensed by the State of Michigan Board of
Psychology.
Evaluation of Client Treatment Needs
The first few sessions will be dedicated to assessment and evaluation to determine a client's specific treatment needs.
The goal of these evaluative sessions will be to clarify if the Clinic is capable of serving the client's specific needs and, if
so, to develop a treatment plan with him or her. If it is determined that the Clinic is not capable of meeting a prospective
client’s needs, we will try to provide referrals to more suitable community mental health practitioners or agencies. Please
note that although we can provide information about area resources during this referral process, we cannot guarantee
that any other agency would necessarily be able to meet a person’s needs.
Clients should be aware that psychological services involve a joint effort between Therapist and Client, the results of
which cannot be guaranteed. For example, progress in therapy depends on many factors including motivation, effort, and
other life circumstances such as the client’s interactions with family, friends, and other associates.
Confidentiality
State laws and the code of ethics for psychologists protect a client’s rights of privacy, privileged communication, and
confidentiality regarding psychological services. Clinic personnel will not release any record of a client’s contact with the
Clinic without her/his written permission, except under the rare conditions outlined below. For EMU students, clinic files
are NOT part of academic records, and no one has access to them except for Clinic staff. Complete records are
maintained for seven years after treatment ends (or, for minors, records are maintained for seven years after the client
reaches 18 years of age).
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Client Information Statement (Rev. 5/15)
Despite our strict respect for clients’ confidentiality rights, the following are situations that may impose limits on a client’s
right to confidentiality based on state laws and ethical principles for mental health professionals.
1. If Clinic personnel receive information that gives them cause to believe that a child’s or disabled person’s
physical or mental health or welfare has been or may be adversely affected by abuse or neglect, they are
required to report this information to the Michigan Department of Child Protective Services.
2. If Clinic personnel receive information that leads them to determine that there is a probability of imminent
physical injury by the client to himself/herself or to others, or where there is probability of immediate mental or
emotional injury to the client, they are required to report this information to the appropriate persons and/or
agencies. In such cases, we will only disclose what we feel is the minimum amount of information necessary to
address the situation.
3. In certain court proceedings, Clinic personnel may be required to disclose specific information regarding a
client, but only when ordered to do so by a judge and/or by state law. If we receive a subpoena to disclose
information that a client has provided, the client will be informed of this, but we may not be able to prohibit
disclosure if it is court-ordered.
4. If crimes are committed on clinic premises, we reserve the right to report these offenses to the appropriate
legal authorities. When an applicant or client commits or threatens to commit a crime while on Clinic premises,
staff may seek the assistance of an appropriate law enforcement agency or report the crime. Staff may provide
the law enforcement with the circumstances of the crime, the suspect’s name, address, last known whereabouts,
and status as a client of the Clinic.
5. If the Michigan Board of Psychology or other licensing or accrediting body is investigating a clinician against
whom you have filed a formal complaint, the Clinic may be required to disclose protected health information
regarding your case.
These policies of confidentiality apply to all Clinic activities with clients, including supervisory contact between Student
Therapists and Faculty Supervisors.
Client Rights
1. Right to Receive Confidential Communications by Alternative Means and at Alternative Locations: You have
the right to request and receive confidential communications by alternative means and at alternative locations.
For example, you may not want a family member to know that you are being seen at the Clinic. On your request,
the Clinic will communicate with you at another address or alternate phone number.
2. Right to Inspect and Copy: You have the right to inspect or obtain a copy (or both) of your Clinic records. A
reasonable fee may be charged for copying. Access to your records may be limited or denied under certain
circumstances, but in most cases, you have a right to request a review of that decision. On your request, we will
discuss with you the details of the request and denial process.
3. Right to Amend: You have the right to request in writing an amendment of your health information for as
long as records are maintained. The request must identify which information is incorrect and include an
explanation of why you think it should be amended. If the request is denied, a written explanation stating why
will be provided to you. You may also make a statement disagreeing with the denial, which will be added to the
information of the original request. If your original request is approved, we will make a reasonable effort to
include the amended information in future disclosures. Amending a record does not mean that any portion of
your health information will be deleted.
4. You also have the right to:
 Be treated with respect and dignity, in a safe, clean, private treatment environment
 Actively participate in your treatment plan
 Know if you are participating in any research study or experimental treatment
 Know who is supervising the work you do with the student Therapist(s) you see
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Have information about you and your treatment kept confidential with the requirements of the law
Stop treatment with the EMU Psychology Clinic at any time
Email Policy
Given that email is never fully confidential, it is our policy NOT to use email for communication of any kind with
Psychology Clinic clients. Our Front Desk staff (734-487-4987) will be happy to take messages for you if you need to
reach a student Therapist, Faculty Supervisor, or the Clinic Director.
Fees, Billing, and Missed Appointments
Clients are financially responsible for all charges incurred regardless of whether or not they choose to submit
reimbursement claims to their insurance company. Typically, insurance companies do not cover services from the Clinic,
but we will provide billing statements if you wish to submit them to an insurance company or for reimbursement from a
flexible spending account.
Payment for services is expected at the conclusion of each session. If necessary, arrangements for establishing a payment
plan with the Clinic can be made by discussing the matter with the Therapist. Clients must make some payment toward
their total Clinic bill every three sessions at a minimum. Clients are considered to have delinquent Clinic accounts and
must negotiate a payment plan before scheduling further appointments if: their account balance exceeds four times the
hourly rate. Therapy is billed at the standard rate of $10/hour for individual therapy and $5/hour for group therapy. These
fees are not negotiable.
Clients are responsible for notifying the Clinic Office if they must cancel or re-schedule an appointment. Clients are
strongly encouraged to provide at least 24 hours’ notice for cancelled/rescheduled sessions, as a matter of courtesy. If a
client misses an appointment without notifying the Clinic Office at least four hours in advance, she/he may be billed for
the missed appointment. Appointments scheduled before 12:00 PM (noon) require cancellation notification by 8:00 AM
(and it is entirely acceptable to simply leave a voicemail message at any time during the night prior to the session) to
avoid a charge for the missed appointment. In general, Therapists are available only at the time of a scheduled
appointment and may wait no more than 20 minutes for a client who is late for his/her appointment.
Important Note Regarding “No Show/No Call” Situations with Assessment Cases: Assessment batteries are
billed at a flat rate of $200. Because of this flat fee that is not based on time, if a client violates the above cancellation
policy, it is not possible to charge an “hourly” rate for the missed session. Therefore, Therapists will discontinue testing
and prepare an abbreviated report if a client “no show/no calls” (or calls late) two or more times after the first visit. This
short report will summarize whatever data have been obtained, and it will simply note that the client failed to attend
scheduled visits, so the full assessment could not be completed. Therapists are also encouraged to refrain from
rescheduling assessment intakes if a client misses more than one intake appointment, since we typically have many
people waiting for assessment openings.
Research Activities
Clients may be asked to participate in research activities conducted in the Clinic, but they will not be included in a specific
research project without written consent. Participation in research activities is voluntary and is not a condition of receiving
services in the Clinic. Archival studies and ongoing continuous quality improvement assessments involving Clinic records
may be conducted in a manner that protects clients’ anonymity and confidentiality of records. All research projects
conducted in the Clinic must be approved by University/Departmental authorities and are conducted in a manner that
protects the privacy and safety of participants.
Contraband / Concealed Weapons Prohibited
The Clinic defines contraband as:
 any alcoholic beverage
 drugs that are not prescribed
 all drug paraphernalia
 firearms or other weapons
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explosives
any other substance or object that may be harmful to the client, other clients, or staff
If, at any time, it is apparent that the applicant/client possesses a contraband item, the individual will be asked to leave
the premises. If there is any threat to people or property, the police will be contacted for assistance.
Emergency Procedures
The Clinic cannot provide 24-hour emergency or crisis management services to the community or to its clients. When the
Clinic is not open, persons in crisis are advised to seek emergency services through one or more of the following service
agencies.
National Suicide Prevention Lifeline
(800) 273-8255
University of Michigan 24-hour Psychiatric Emergency Services
(734) 996-4747
University of Michigan 24-hour Crisis Line
(734) 936-5900
Washtenaw County Community Support and Treatment Services 24-hour Line
(800) 440-7548
Safe House 24-hour Crisis Line (Domestic Violence)
(734) 995-5444
First Step 24-hour Help Line (Domestic Violence)
(734) 722-6800
University of Michigan Sexual Assault Prevention &
Awareness Center 24-hour Crisis Line (Sexual Assault)
(734) 936-3333
Eastern Michigan University Counseling and Psychological
Services After-Hours Phone Service (EMU Students only)
(734) 487-1118
Or, call 911.
If you have any questions or are not sure that you are clear about any of these policies, please feel free to
discuss them with your Therapist.
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Acknowledgement of Receipt of
Eastern Michigan University Psychology Clinic Client Information Statement
I acknowledge that I have received a copy of the EMU Psychology Clinic’s Client Information Statement. I affirm that
I have read and understand the policy and procedure statements in this document, and have received a copy of this
document.
Client or Guardian, Signature
Date
Clinician, Signature
Date
Please detach this page.
Client, please retain pages 1–4 of the Client Information Statement for your records.
Clinician, please retain and file this acknowledgement page.
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