Bitterroot Valley Education Cooperative
YOUTH ENHANCEMENT PROGRAM
PO Box 187
Stevensville, MT 59870
Phone: (406) 777-2494 FAX: (406) 777-2495
MENTAL HEALTH RIGHTS AND CONSENT FOR TREATMENT
Mental Health Rights
You, your child and have the right:
1. To be treated in a non-discriminatory manner and with dignity and respect.
2. To be free from abuse and neglect, or threats of abuse and neglect while receiving
mental health services.
3. To a humane psychological and physical environment while receiving services.
4. To appropriate treatment under conditions that support personal liberty.
5. To not be subjected to experimental research or other experimentation without
your informed, voluntary, and written consent.
6. To receive the maximum amount of privacy consistent with the delivery of services.
7. To receive a reasonable explanation of:
a) your child’s general condition
b) treatment objectives
c) the nature of the recommended treatment and possible adverse
d) reasons this treatment is considered to be appropriate
e) any available alternative services
8. To participate in the development of an individualized treatment plan.
9. To access, review, and correct confidential records.
10. To be free from excessive or unnecessary or excessive medication, and to give
informed consent to take or not take prescribed medication unless:
b) an emergency situation exists which is life-threatening
11. To receive information regarding the procedure to file a complaint and the BVEC
12. There may be additional rights listed in the Montana Statute, many of which apply
to impatient settings and involuntary commitment.
I understand my rights as a consumer of services from the Youth Enhancement Program:
All information that is documented will be kept confidential. Files are locked when YEP
staff is not present. Access to files in the school is permissible only if there is a legitimate
educational interest. All educational staff log the student’s file indicating the reason for
access and the date. To release information to those outside of the school setting, you
must provide written consent, unless Montana law permits the circumstances. The
exceptions to written consent are:
1. When the student may be a physical danger to self or others the appropriate
authorities will be notified.
2. When the therapist has reasonable cause to suspect abuse or neglect of a child it
will be reported to the Department of Public Health and Human Services.
3. When the State of Montana visits out site to periodically review our files to ensure
compliance to policies, procedures, and treatment requirements.
4. When required by Montana State law, law enforcement can have access to files.
I understand the requirements and exceptions to, confidentiality as required by law:
Consent for Treatment
Having been given the information above, I give my informed consent, as the custodial
parent or legal guardian, for the Youth Enhancement Program to provide mental health
treatment for, a minor child. I understand that I may revoke my
consent to treatment at any time and agree to contact my child’s therapist to terminate
In addition, I understand that the financial eligibility of this child rests on my timely
response to requests from the payer and that any loss of financial eligibility for my child
which occurs through my failure to respond to the payer’s request can result in immediate
discharge of my child from the Youth Enhancement Program.
Consent for Emergency Medical Care
I understand every reasonable effort will be made to notify me prior to any medical
treatment of my child. However, if an emergency is life threatening and the
parent/guardian cannot be reached, I authorize the following:
1. Transfer of my child to a facility able to render the necessary medical care.
2. Release of medical records and/or information to the facility providing medical care
to my child.
Consent for Physical Restraint
Co-op policy requires non-aversive treatment plans for all clients. Treatment plans focus
proactive strategies including environmental changes, skill development and reinforcing
desired behaviors. Plans will also include reactive strategies designed to de-escalate
behavior and maintain the dignity of our clients. No plans designed buy Co-op staff will
require physical restraint as an intervention or strategy. In the unlikely event a student is
unable to gain control of his/her behavior and is directly harming himself/herself or others
and reactive strategies are not successful in deescalating behavior, Co-op staff may
physically restrain client. If a restrain is used, Co-op staff will notify parent on that same
day and call a treatment team meeting to review and revise treatment plan to minimize
chances another hold will be necessary. A treatment plan change and review must be
conducted within 5 working days of the occurrence where a physical restraint was used.
Staff is also required to submit a report detailing antecedents and responses to the
behavior requiring the physical restraint to program supervisor within 10 working days.
Every effort will be made to assist a student without using physical contact.
I understand and accept the Co-op physical restraint policy.
Consent to Participate in Treatment
I understand my involvement with treatment is essential to successful treatment of my
child. I understand that CSCT services may include family therapy, parent education,
home visits and home behavior intervention plans. I am willing to meet regularly with YEP
staff at school, attend all necessary family sessions and actively participate in my child’s
treatment planning and implementation.
Consent for Private Transportation & Release of Liability
I give my permission to the Bitterroot Valley Education Co-op’s Youth Enhancement
Program Staff to transport to and from YEP activities.
This document has been reviewed and initialed this date:
Signature of Parent/Guardian Date
Signature of Therapist Date