Couples Therapy

Eligibility

• Couples therapy is available to both new and existing clients. 
• Existing clients can either use a new email to access care or have their partner sign up. 
  • For example, if an existing client has an account linked to danielle.buck@aol.com, they could use daniellebuck@gmail.com (new email) OR danielle.buck+1@aol.com (add “+1” to make system think it is a new email) to access couples care in parallel. 
  • This is also true for clients in couples care who want to access individual therapy or medication services. 
• We can check eligibility in the Therapist View AirTable under the ‘Couples Therapy ON/OFF’ column. 
  • Use the following filters:
    • Couples Therapy = On
    • Status = Active
    • Cash = On
    • Therapist Active States = state in which client is located
• We are currently only able to provide couples therapy services to a couple consisting of 2 partners due to technical platform constraints. 
• Due to the fact that many insurance plans don’t consider couples therapy to be a covered benefit, we do not accept insurance for couples services at this time.
  • For more information, use the macro included in this Help Center article.
• Reasons a couple may NOT be eligible:
  • Recent or current domestic abuse in the relationship
  • Untreated substance use by either or both partners
  • Untreated severe and persistent mental illness by either or both partners (does not include history of postpartum depression)
  • Therapy is mandated by the court or there are current legal proceedings for civil, criminal or custody. 
• Resources for couples who are not eligible:
  • Domestic abuse: Home  
  • Substance use disorders: SAMHSA - Substance Abuse and Mental Health Services Administration  
  • Mental illness: www.nami.org 

Couples therapy experience

Overview

1. Partner 1 signs up for couples therapy.
   1. This includes selecting a Therapist and scheduling the initial session.
2. Partner 1 invites Partner 2 by adding in contact information for their partner during the sign up process.
3. Both partners receive automated welcome emails that include a link to complete their intakes via Typeform and read Cerebral Terms & Conditions. 
   1. Both partners should complete their intakes prior to their initial session.
   2. When their intake is completed, they will automatically receive a confirmation via email.
   3. An alert with completed intake responses will be automatically sent to support@cerebral.com. 
4. Both partners receive calendar invites for their initial session via email.
5. Both partners receive email reminders regarding their upcoming session.

ID verification

• The account holder will go through our standard ID verification process and have an image of their ID uploaded to the EMR. 
• Partner 2 will show the therapist their ID for verification in the couple’s initial session and will NOT have an image of their ID uploaded to the EMR. 

HIPAA verification

• Both partners can provide their own information as HIPAA verification to access their couple account. The account holder’s information will be listed in the ‘Patient info’ tab and Partner 2’s information will be listed at the bottom of the EMR in the ‘Couples Therapy Partner Information’ section for us to verify.
• Both partners will have emergency contacts in the EMR. 
  • Partner 1’s emergency contact will be displayed in the profile section of the ‘Patient Info’ tab.
  • Partner 2’s emergency contact will be available in their completed intake, which will be uploaded to the ‘Images’ tab. 

Scheduling cadence 

• There are 4 total intake sessions for couples therapy, each being 60 minute sessions:
  • 1 initial session with both partners
  • 2 individual initial sessions
  • 1 treatment plan intake with both partners
    • All intake sessions should take place within the first 3 - 4 weeks.
    • We cannot book two visits for a single EMR on the same day.
• Once all intake sessions are complete, the standard couples therapy visit cadence is ongoing visits 2x per month with both partners.
• Due to the nature of couples therapy and the concept of a “client unit”, if one partner is unable to attend a scheduled session, that session will need to be rescheduled. 
  • It is the Therapist’s responsibility to reschedule the session, but the account holder will be able to do so from their account as well.

During the initial session

• The Therapist will receive verbal confirmation from both partners that they have completed their intakes.
• If either partner’s intake is still incomplete, the Therapist will:
  • Have the partner(s) complete their intake(s) during the session.
  • If no intake(s) were found on file but client(s) confirm submission, create a Couples > Missing intake task to notify Support.
  • Once received, Support will:
    • Check the Couple Therapy Master List again. 
    • If the missing intake(s) are located, upload them to the ‘Images’ tab in the respective EMR and document intake completion in Column Q of the Couple Therapy Master List.
    • If the missing intake(s) are NOT located, follow up with both partners via email using the macro provided in the ‘Couples EMR Tasks’ section below.

After the initial session

• The therapist will schedule two individual sessions for both partners, plus one joint follow-up session to take place after each partner’s individual session.
• In the session note, the therapist will document which partner is going to which session.
• The therapist will communicate to both partners that because of the way our system works, both partners will receive calendar invites and session reminders for both individual sessions, but they can decline the session that isn’t relevant to them.
• [OPTIONAL] The therapist can send an email after the first session to both partners with who is attending which calendar session.

Interacting with couples therapy accounts

The plan type in the EMR will be ‘Couples therapy’, as shown below.

Partner 1 & Partner 2

• Partner 1: The partner who signed up on behalf of the couple. As the account holder, the account is under their name and they are responsible for payments. 
• Partner 2: The partner who was invited by the account holder. 
  • Partner 2’s information is located:
    • At the bottom of the EMR in the ‘Couples Therapy Partner Information’ section, as shown below.

• This information can be edited by selecting the ‘Edit Info button’.

• In the summary view in the EMR under the 'Contact Info' column. 
  • Partner 2's email is indicated via the (P) label in the second line for relevant accounts, as shown below.

• To add Partner 2’s email to the couples therapy account, follow the steps in our Account Management > Adding secondary account emails SOP. 

• Partner 1 [account holder] ONLY can:
  • Cancel the account
  • Reactivate the account
  • Access the couple’s account to utilize the following UNLESS they share login information with Partner 2 [which we encourage]:
    • Task system
    • Scheduling
    • Edit account information 
• Both Partner 1 and Partner 2 can:
  • Request to schedule, reschedule, or cancel sessions
  • Request reassignment 

Missed Sessions

• If one partner misses a session, the Therapist will reschedule the session. 
• If both partners miss a session, the Therapist will create a Couples > Missed Session task for the Support team to follow up with both partners via email using the macro below after editing appropriately: 

[Subject: Missed Session Follow Up]

Dear [Partner 1] and [Partner 2],

We hope you're both doing well. We are reaching out because we noticed that your last couples session with us was missed and we’d like to assist you in rescheduling your session as quickly as possible. Either of you can use the link provided below to choose another time that works for you: [ad hoc link]

We are committed to your couple’s journey and hope to help you prioritize it as effortlessly as possible. Please let us know what we can do to ensure that you get the care your relationship needs.

If there are any challenges that prevent either of you from attending your couples sessions, please let us know. We are here to support you and look forward to addressing any concerns or obstacles that may be impacting your care.

Reassignment 

1. If either partner contacts us requesting to change their couples therapist, respond to both partners via email using the following macro after editing appropriately: 

[Subject: Couples Therapy Reassignment Request]

Dear [Partner 1] and [Partner 2],

We hope this message finds you well. We are reaching out because we have received a request regarding a potential reassignment of your couples therapist. Our priority is to ensure that both of you feel comfortable and supported throughout this process.

We kindly ask if this request for a therapist change is a mutual decision or if either of you would like to discuss it further with your current Therapist before making any changes. 

If this is a mutual decision and you’d like to proceed with reassignment, please let us know by responding to this email and we will be more than happy to reassign you to another qualified professional. We understand that the relationship between a couple and their Therapist is important, and we want to ensure your comfort and satisfaction so that you have the best possible experience. Understanding the reasons behind the reassignment request is important to us, so we would appreciate it if you could share with us the motivation behind this decision. This will ensure we are able to prioritize matching you to a new Therapist that meets both of your needs and goals. 

We are here to support you through this and look forward to hearing from both of you.

2. Submit the ticket as ‘solved’.
3. Do NOT take further action on reassignment until we receive confirmation from both partners that this is a mutual decision. 
   1. If one partner responds with an affirmative decision and the other partner is CC'd on the email, we consider that confirmation from both partners and can proceed. 
4. Once confirmation from both partners is received, proceed with a manual reassignment following our Client Requested Reassignments > Manual Reassignments via AirTable SOP.
   1. Check the Therapist View AirTable under the ‘Couples Therapy ON/OFF’ column.
      1. Use the following filters:
         1. Couples Therapy = On
         2. Status = Active
         3. Cash = On
         4. Therapist Active States = state in which client is located

Medical records requests

1. If either partner submits a request for their medical records to be sent to one of the email addresses associated with the couples account:
   1. Create a Couples > Medical records request task for the Therapist.
      1. The Therapist will determine if there is any potential risk of harm to the client or others in fulfilling the request. 
      2. The therapist can also request redactions to the record in order to accommodate the request. 
   2. Proceed according to the advice of the Therapist and our Medical Records Requests > Client requested medical records, sent to themselves SOP. 
2. If either partner submits a request for their medical records to be sent to a 3rd party:
   1. Advise both partners via email that they each need to complete a HIPAA authorization to agree to any disclosures of medical records going to a 3rd party.
   2. Complete the steps in our Medical Records Requests > Client requested medical records, sent to a 3rd party SOP for both partners.
   3. If both partners do not agree, email compliance@cerebral.com. 
      1. Compliance will work with the Therapist and requesting party towards a suitable alternative.
      2. Proceed according to the advice of Compliance. 

Request for couples care or individual care

In either scenario noted above, follow up with the client to inform them how they can do so using the following macro after editing appropriately: 

[Subject: Expanding your Cerebral care]

Hi [client name], we are reaching out because your Therapist informed us that you’re interested in utilizing Cerebral for [couples/individual] care in addition to your current [couples/individual] care. We are thrilled to hear this and wanted to reach out to support you in the process. 

Because your email address [email address on file] is associated with your current [couples/individual] account, you will need to create a new account in order to access [couples/individual] care in parallel. There are 2 ways you can do this:

• Sign up using a new email address
• Sign up by adding ‘+1’ to your existing email address

You can sign up using this link: https://cerebral.com/app/welcome. 

If you have any questions or concerns, please don’t hesitate to reach out.

We look forward to supporting you on both journeys! 

Cancellation

If Partner 2 contacts Support wanting to cancel:

1. Follow up with the account holder using the macro below after editing appropriately to confirm that the account cancellation is a mutual decision before taking any action. The account holder MUST approve the account cancellation in order to end payments. 

[Subject: Account Cancellation Request]

Dear [Partner 1] and [Partner 2],

We hope you both are doing well. We are reaching out because we have received a request to cancel your couples account. Our policy requires us to ensure that such decisions are mutual before proceeding with any action.

Please let us know at your earliest convenience if both of you approve the account cancellation. Your response to this confirmation is important to us, and we want to make sure that this decision aligns with both partners' intentions.

We look forward to hearing from you both. 

2. Submit the ticket as ‘solved’.
3. Once confirmation from both partners is received, proceed with cancellation following our Cancellations > Coordinator assisted cancellations SOP.

Project owner workflow

On a daily basis, our project owners will complete the tasks detailed below. 

1. Review and upload newly completed intakes.
   1. An alert with completed intake responses will be automatically sent to support@cerebral.com and received via ZenDesk. 
      1. Search for the subject line "Typeform: New response for Couples Therapy Intake".
      2. Example: https://cerebral.zendesk.com/agent/tickets/3194484
   2. Download completed intakes.
      1. To the right of the subject line of the ZenDesk ticket, click the three vertical dots. 

2. Click 'Print ticket'.
3. Ensure the 'Destination' dropdown says 'Save as PDF'.
4. Ensure each completed intake has a unique file name to differentiate them once downloaded. This will also prevent any errors when uploading them to the EMR.
5. Click 'Save'.

3. Upload completed intakes to the ‘Images’ tab of the relevant EMR.
4. Document intake completion in Column Q of the Couple Therapy Master List.

2. Review couples with initial sessions within 48 hours.
   1. Check Column K in the Couple Therapy Master List for any upcoming sessions within 48 hours.
   2. Go to the respective EMR to confirm that there is a completed intake for both partners uploaded in the ‘Images’ tab. 
   3. If intake(s) are incomplete, follow up with both partners via email reminding them to complete the missing intake(s) before the upcoming session using the following macro after editing appropriately:
      1. [Subject: Reminder - Complete intake assessments]
         Dear [Partner 1] and [Partner 2],
         We hope you both are doing well. We are reaching out to send a reminder regarding completing both of your intake assessments prior to your upcoming session on [date and time]. This will ensure your initial session goes smoothly and we have all of the necessary information to support you on your couples journey here at Cerebral. 
         If you need assistance in locating the intakes, please refer to the welcome email that was sent to both of you on the day you signed up for couples therapy to the addresses we have on file.
         Thank you for your cooperation and we look forward to your upcoming session!
   4. Submit the ticket as ‘solved’.
   5. Document outreach completion in Column R of the Couple Therapy Master List.
   6. On the day of the visit, check to see if the missing intake(s) are now completed and if so, repeat steps 1c - 1e.
3. Review any Couples tasks submitted following the steps below and complete the appropriate next step, depending on the task. 
   1. In the EMR, click on the ‘Tasks’ button in the upper right corner.
   2. Use the ‘filter’ button to add the following:
      1. Status: Open
      2. Assignee: Unassigned
      3. Category: Couples
      4. Tasks:
         1. Missing intake
         2. Missed session
         3. Request individual care
         4. Request couples care
         5. Medical records request
4. Review completed joint follow-up sessions via the Couple Therapy Master List each day. 
   1. Send follow-up assessments via email to both partners for any completed joint follow-up sessions.