Terms + Conditions.
Please Note: This document outlines important details regarding the psychological services offered by me, Mishawn Davis, LPC-T. Please read the following information carefully and ask any questions you may have.
CLINICIAN INFORMATION
• My name is Mishawn Davis, LPC-T, and I am a licensed professional counselor-temporary with the state of Kansas and Missouri.
• My license number is LPC 05041-T.
• I am under the direct supervision of Kari Gregory, LCPC. Should you have any questions or concerns regarding the care I provide, she can be reached via email: Kari@panaceakc.com.
• You can find more information about my qualifications and experience on my website: thecollectivetherapykc.com under the ABOUT section.
OFFICE HOURS
My hours of operation are as follows:
Monday and Tuesday: 9a – 1p, 3p – 6p
Wednesday - Saturday: 9a – 11a
Sunday: CLOSED
My therapy office observes all major holidays. The office will be closed for a two-week summer break from July 20 – August 3. You will be notified of any scheduling changes at your preferred method of contact.
CONTACTING THE CLINICIAN
You, the Client, have the right to consent to how you want to be contacted. You will have the opportunity to confirm your preferred method of contact prior to beginning the therapeutic relationship.
I can be contacted by the following:
Email: mishawn@thecollectivetherapykc.com
Phone (including text): (913) 578.8087
• If you, the Client, should need to contact me either by phone (including text messaging) or email, at any time outside of scheduled sessions, please understand I will make every effort to return your call/text/email within 12-24 hours.
• Correspondence is limited during daytime hours, as I may be in another therapy session.
• Correspondence made by you, the client, after hours (Monday through Friday after 7p, and before 9a) will be answered during the business hours highlighted above. Weekend correspondences will have a delayed response. The clinician will not be available for contact during major holidays.
• If you cannot reach me and require immediate help, call 911 or call 988.
• In case of an extended absence on my part, the client will receive contact information of my supervisor, Kari Gregory.
Should you require more assistance you may contact the following:
JOCO MENTAL HEALTH (913) 268-0156
WYCO MENTAL HEALTH (913) 788-4200
JACKSON CO MENTAL HEALTH 888-279-2132 or text HELLO to 741741
CLINICIAN RESPONSIBILITIES
As your clinician, I am committed to:
• Providing my clients with culturally competent, holistic, and ethical psychological care.
• Respecting my client’s privacy and confidentiality, both in and out of the therapy space.
• Discussing limitations of my expertise and referring clients to another licensed clinician if necessary.
SERVICES OFFERED
I provide the following services for the listed populations:
· Individual therapy for domestic violence offenders, victims, and families.
· Individual therapy for adolescents (12+) and adults navigating complex trauma, and PTSD.
· Community-based therapy as a mobile crisis response case manager.
• Couples therapy for adults, ages 18+, experiencing a challenge related to relationship strain, distress, and perinatal concerns.
• I utilize an integrative approach to the therapeutic alliance, as each client is different and requires a variety of interventions.
• I do not offer medication management, after-hours crisis care, therapy specializing in eating disorders, or intensive therapy involving severe mental illness and/or EDMR.
EVALUATION
• The first few scheduled sessions may involve an evaluation of your needs and therapeutic goals. Should an evaluation be required, the evaluation period typically lasts three sessions.
• At the end of the three sessions, we will discuss if I am the right therapist for you and will proceed with a collaborative treatment plan.
• If it is determined I am not a good fit, I will provide therapeutic referrals for licensed clinicians.
DEFINITION OF PSYCHOTHERAPY
• Psychotherapy is a collaborative effort which requires active participation from you, the client.
• The approach utilized may vary depending on your therapeutic needs and goals and may involve discussing
uncomfortable topics.
• There are no guarantees about therapeutic outcomes, however, current studies have provided the benefits of consistent psychotherapy for those who undergo it.
THERAPEUTIC BENEFITS & RISKS
• Therapy requires a significant investment of time, money, and energy. Therapy can be a helpful and effective
way to address emotional and behavioral difficulties.
• Potential benefits of therapy may include improved mood, reduced stress, better coping skills, and
enhancement to meaningful relationships.
• Please understand, therapy may also involve emotional discomfort as you explore challenging issues.
• You are encouraged to ask questions during your scheduled sessions. You also have the right to seek a second opinion at any time during the therapeutic process.
CONFIDENTIALITY
Information discussed during scheduled therapy sessions are kept private and confidential, unless explicit written permission is provided. Please know confidentiality has limitations. If there is any threat to your life, I have the duty to abide by ethics to ensure the appropriate care is provided. Situations where I am mandated to report and break confidentiality include:
• Active threats against another person or myself, including children.
• Active threats against yourself.
• Any form of abuse to myself or another person, including children.
• Any form of abuse or exploitation of children or the elderly population.
• Any form of abuse or exploitation of individuals who are disabled.
• Physical or sexual abuse, neglect, Pregnant women who report using drugs.
If any of the above occurs during a scheduled session, I will attempt to inform any individuals of your intentions.
I will also contact the police for assistance in protecting the intended victim. In the event you threaten to harm a child, Kansas Child Protective Services will be contacted within 48 hours. In the event elderly or disabled individual is threatened with harm; Kansas or Missouri Adult Protective Services will be contacted immediately.
· If you, the Client, is in imminent danger of harming yourself, I may legally break confidentiality and call the police and/or the Johnson or Jackson County crisis response team. This a last resort and I would first explore all options with you prior to escalating to this step.
If after processing your suicidality, you remain unwilling to take steps to
guarantee your safety, or the mood/behavior has not improved, I will seek assistance from the Johnson or Jackson County Mental Health crisis team.
Please note: Mandatory reporting laws vary by state. In some states, not all suspected abuse would be mandated for reporting by law. It is always recommended you review relevant laws and regulations in Kansas and/or Missouri. I may also be required to disclose information if compelled by a court order.
The situations above are not exhaustive and as a clinician, I have the right to exercise discretion. This may include necessary steps to ensure your safety and/or the safety of others. I may consult with my supervisor, Kari Gregory, and/or other licensed mental health professionals about your case to provide you with appropriate care. If I do such consultations, I will make every effort to avoid revealing information which could
compromise your identity and privacy.
ELECTRONIC COMMUNICATION
I recognize the challenges you as a client can experience in and out of the therapy space, and I will do what I can to be a collaborative partner throughout our therapeutic alliance. Even when I can’t discuss certain details with you, I will ensure to provide the appropriate guidance while encouraging healthy decisions, including being open and honest with you.
Your information is kept confidentially via an Electronic Health Record (EHR) via SimplePractice. The information stored includes intake paperwork, credit card information, and signed documents. These documents are not shared with anyone outside of The Collective Therapy KC. Should you request your notes, treatment plan, or other clinical documentation, a Release of Information must be signed.
Once the therapeutic relationship is terminated, your EHR profile will be archived, and the provided information will remain on file for seven years. After the seven-year period, the information will be safely destroyed.
I will always act to protect your privacy, even if you explicitly give permission to share information about you.
You may direct me to share information with whomever you choose, and you can change your mind and revoke that permission at any time. You may request anyone you wish to attend a therapy session with you. A Release of Information (ROI) must be signed before a support person attends therapy with you.
HIPAA ensures the confidentiality of all electronic transmission of information about you. If or whenever I transmit information about you electronically (sending bills or faxing information), it will be done with special safeguards to ensure confidentiality.
Email is done via a HIPPA-compliant platform. If you are in an emergent and/or crisis, please do not utilize this electronic medium, as electronic transmissions are not utilized for after-hours crisis support. Additionally, any correspondence I receive may not be answered in a timely fashion. Please utilize 911 or go to the nearest emergency room.
If you elect to communicate with me via email at any point during our work together, please be aware that email is not completely confidential. Email I receive from you and any responses I send may be printed out and/or kept in your treatment record. If you are concerned about confidentiality in any situation, please bring it to my attention.
Texting is done via the HIPPA-compliant platform RingCentral. If you are in an emergent and/or crisis, please do not utilize this electronic medium, as electronic transmissions are not utilized for after-hours crisis support. Additionally, any correspondence I receive may not be answered in a timely fashion. Please utilize 911 or go to the nearest emergency room.
If you elect to communicate with me via text messaging at any point during our therapeutic alliance, please be aware that texting is not completely confidential. Text messages I receive from you and any responses I send be printed out and/or kept in your treatment record.
If you are concerned about confidentiality in any situation, please bring it to my attention.
SOCIAL MEDIA/NETWORKING
I will not accept friend or other connection requests from current or former clients on the following platforms where personal and business social media accounts are found:
• Meta (Facebook, Instagram, WhatsApp, Threads)
• ByteDance (TikTok, CapCut, Lemon8)
PUBLIC FACING EVENTS & DUAL RELATIONSHIP
The Kansas City Metropolitan Area is a bi-state area and compared to other major cities, is relatively small. There may be a time where you might see me in a public space.
Public spaces include:
Organization or fundraising events
Music venues/Live comedy shows
Amusement/Theme Parks
Library or historical locations
Retail and shopping
This list is not exhaustive and may apply to other locations not listed here. To protect your privacy and confidentiality, I will not engage in any therapeutic discussion or topics should you see me in public and elect to engage in conversation.
If a situation arises in which I know or have an acquaintance with any Client’s family member, friend, etc. who chooses to seek therapy with me, the appropriate safeguards will be put in place, including providing referrals to a licensed clinician outside of The Collective Therapy KC.
FEES
My standard fee for a therapy session is as follows:
PRIVATE PRACTICE
• Individuals (including adults 18+ and adolescents 12-17) - $100
• Couples (ages 18+) - $125
Sessions are typically 50-minutes long. Sessions may run over scheduled time dependent on topics discussed.
The session rate will be prorated to reflect the overage. Tasks under one hour will be pro-rated (meaning the cost will be calculated proportionally to the time spent on the task and not the full hourly rate).
Please note, starting on January 1, 2027, the session fee will increase $10, and will be ongoing until otherwise stated. You will be notified electronically of any pricing changes and or increase sixty days prior to January 1 of the following year. (October 1 of current year.) You will receive another electronic notice thirty days prior to January 1st. (December 1 of current year)
FATHERS 4 CHANGE COURT PROGRAM (DOMESTIC VIOLENCE COUNSELING)
Free – funds provided by the City of Kansas City, Missouri
I am an OpenPath Collective provider, which allows me to provide a sliding scale rate for those who cannot pay the session fee. You can learn more about the program and how to sign up here: https://openpathcollective.org/open-path-staff/
ADDITIONAL FEES
My fees for non-clinical administrative tasks and or services are as follows:
• Phone calls: First 10 mins - $0, 15mins - $25/15 mins.
• Letter: Session Verification/attendance and/or treatment summary: $75/document
• Letter: FMLA, Disability or court: $100 and $5/hour after one hour of time spent.
• Records requests/admin: $25 plus $1 per page.
• Court/legal fees: $200/hour
• 1/2 Day Retainer: $850Full Day Retainer: $1750/day
Please refer to Good Faith Estimate (GFE) for a complete list of fees and services. Fees are subject to change with 30 days’ written notice.
PAYMENT
• The Collective Therapy KC requires a credit card to be placed on file in your HER (Simple Practice). However, you may choose to pay at the time of service by credit/debit card, Venmo, CashApp, HSA, HRA, or electronic transfer.
• Payment is due at the time of service unless otherwise agreed upon.
• I am not currently accepting insurance; however, I can provide you with a detailed superbill that you can submit to your insurance company for reimbursement.
• There is a $100 fee for cancellations and/or no shows with less than 24-hours' notice, and the credit card on file will be charged.
• If your account is unpaid after 10 days, your scheduled sessions will be suspended until the amount owed is paid in full.
YOUR RIGHTS AS A CLIENT
As listed by the NBCC, you, the Client has the right to:
• Select a professional counselor who meets your needs.
• Receive specific information about your counselor’s qualifications, including education, experience, national counseling certifications, and state licensure.
• Obtain a copy of the code(s) of ethics your counselor must follow.
• Receive a written explanation of services offered, time commitments, fee scales, and billing policies prior to receipt of services.
• Understand your counselor’s areas of expertise and scope of practice (e.g., career development, adolescents, couples, etc.).
• Ask questions about confidentiality and its limits as specified in state laws and professional ethical codes.
• Receive information about emergency procedures (e.g., how to contact your counselor in the event of a crisis).
• Ask questions about counseling techniques and strategies, including potential risks and benefits. goals and evaluate progress with your counselor.
• Establish
• Request additional opinions from other mental health assessment professionals.
• Understand the implications of diagnosis and the intended use of psychological reports.
• Obtain copies of records and reports.
• Terminate the counseling relationship at any time.
• Share any concerns or complaints you may have regarding a professional counselor’s conduct with the appropriate professional counseling organization or licensure board. (Kansas BSRB or Missouri Committee for Professional Counselors)
You may request a copy of the client rights at any time during your scheduled session.
YOUR RESPONSIBILITIES AS A CLIENT
• Adhere to established schedules. If you must miss an appointment, contact your counselor as soon as possible.
• Pay your bill in accordance with the billing agreements.
• Follow agreed-upon goals and strategies established in sessions.
• Inform your professional counselor of your progress and challenges in meeting your goals.
• Participate fully in each session to help maximize a positive outcome.
• Inform your counselor if you are receiving mental health services from another professional.
• Consider appropriate referrals from your counselor.
• Avoid placing your counselor in ethical dilemmas, such as requesting to become involved in social interactions or to barter for services.
AGREEMENT
By reading the above information, you acknowledge you have read and understood this Informed Consent document, you have had all your questions answered to your satisfaction, and you consent to any release of information described above. You agree to participate in therapy voluntarily.