Trans Wellness Intake Form and Agreement

A webform by Podio

Trans Wellness Group Agreement

About Group Counseling Services with Transgender Wellness

Transgender Wellness, a program of Out Youth, seeks to provide holistic support to transgender individuals. This includes providing counseling services, including a support group.

The Gender Affirmation group combines peer support, psycho-education, and processing related to trans identities and gender affirmation experiences.  

A support group can be a powerful and valuable venue for healing and growth. To help this occur, groups are structured to include the following elements:

- A safe environment in which participant are able to feel respected and valued

- An understanding of group goals and group norms

- Investment by both facilitator(s) and members to produce a helpful group experience

This group consists of both teaching and processing time. Processing may revolve around an issue one member of the group is working on with time for structured feedback and reactions by other members of the group. At times the group may focus on a topic with all members verbally participating. In either case, the group dynamic offers a place where participants can experience support, give support, and understand more clearly how they relate to others.  

Facilitator Qualifications

This group is facilitated by a Licensed Counselor or Licensed Counselor Intern or Licensed Social Worker, who may be assisted by a graduate student counseling or social work intern. All students are working toward Master’s Degrees in Professional Counseling or Social Work. All clinical staff receive ongoing clinical supervision to ensure clients receive high-quality therapeutic services. Specific information about clinical supervision is available upon request. Staff regularly consults with coordinating/supervising personnel. Supervision complies with the Texas State Board of Professional Counselors and Texas State Board of Social Workers. Licensed counselors and supervisors comply with the Texas Administrative Code, chapter 681 and the Health and the Texas Safety code, Chapter 611.

Contacting Us & Crisis Situations

As Transgender Wellness, a program of Out Youth, is not a crisis center, staff are often not immediately available by telephone or via email. Clients may leave a message on the confidential clinical/social services voicemail at 512-419-1233 ext. 1106 or send a counselor a message via email.  We will make every attempt to get back to you within 48 hours. Please be aware that email is not a confidential means of communication and not an appropriate way to communicate confidential, urgent, or emergency information. If, for any number of unseen reasons, you do not hear from staff and you feel unable to stay safe, go to your local hospital Emergency Room or call 9-1-1 and ask to speak to the mental health worker on call. In Travis County, you can also call 512-472-4357 to be connected to crisis mental health services. Further mental health crisis resources are available upon request.

Fees and Record Keeping

Group counseling services offered by Transgender Wellness are currently offered free of charge, so no payment is necessary for our services. Clinical staff are required are required to keep appropriate records of the services we provide. We will collect a sign-in sheet for each group session.  

Confidentiality and Creating a Safe Environment in Support Group

A safe environment is created and maintained by both the facilitator(s) of a group and its members. Primary ingredients are mutual respect and a chance to create trust. Another primary ingredient for a safe environment has to do with confidentiality. Your group facilitator(s) are bound by law to maintain confidentiality, as group members are bound by honor to keep what is said in the group in the group.

Generally, discussions that take place in group are confidential, and thus cannot be shared without written permission. However, the following are general limits of confidentiality, situations where information may be shared by facilitators without your written consent:

  • If we believe someone is likely to harm themselves or another person, we may take action necessary to protect them or others by contacting law enforcement or another mental health professional;

  • If we have cause to believe a child, elderly, or disabled person has been or may be abused or neglected, we are required to make a report to the appropriate state agency;

  • If a someone reports sexual contact which is unlawful;

  • If information is requested by court-order.

Consent to Communicate with Other Professionals

At times, a clinician may request written permission to speak with someone else (for example, a doctor or psychiatrist) so we can best meet the needs of a participant in group counseling. If a client in group is currently receiving individual therapy from another professional, we may request written permission to speak with the other provider to coordinate treatment goals and provide consistency in care.

Appropriate Referrals, Group Commitment, and Termination

If severity of particular symptoms or behaviors (e.g. suicidal ideation, self-harm) are apparent in a participant in group, we may recommend admission to an inpatient, partial hospitalization, or intensive outpatient program, or individual therapy in place of, or in addition to, continuing group.

As the Gender Affirmation group is an “open” group, participant can choose to discontinue or re-enter group at any time. You are encouraged to provide feedback to the group facilitators about the group so it can best meet your needs.