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1. Scope

1.1. The purpose of this procedure is to provide direction on the provision of Open Arms counselling and treatment services.

1.2. Refer to the Clinical Assessment and Treatment Planning Procedure for guidance in relation to clinical assessment.

2. Background

2.1. Open Arms provides counselling as part of a suite of services to promote recovery, resilience, and autonomy, and to assist clients and their partners and families to resolve mental health issues and improve wellbeing. Open Arms counselling uses evidence based treatments for mental health conditions. While supportive counselling may be suitable for general life concerns such as adjustment to life transitions, it is not recommended for the treatment of mental health conditions or disorders.

2.2. This instruction has been developed for use by the mental health professionals (psychologists, occupational therapists, registered nurses and social workers) who provide counselling services to clients in, or on behalf of, Open Arms and is intended to complement each of the professional groups’ discipline-specific practice standards or competencies.

2.3. Open Arms endorses professional ethical codes / practice standards (APS,[1] OTAus[2], ACMHN[3] and AASW[4]) and professional counselling principles (Refer to point 4.1).

3. Expected Outcomes

3.1. Counselling promotes mental health and wellbeing, and assists clients to address their presenting issues in a positive way through insight, exploration, problem solving, and enhanced self-awareness.

3.2. Clients receive evidence-based counselling interventions informed by comprehensive assessment, case formulation and treatment planning. See Assessment and Care Planning Procedure for further information.

3.3. Counselling promotes respect for clients’ choices and autonomy, client rights (including privacy and confidentiality) and client dignity (value for individual and cultural differences).

3.4. Counselling supports the contribution Open Arms makes to the mental health and wellbeing of the client, their family and children, and the development of a trusting relationship between the clinician and client.

3.5. Counselling is based on clear professional boundaries between the clinician and their client that ensures clinical integrity and safe delivery of care.

3.6. Counselling is based on fairness and equity of access to services – Open Arms has a ‘no wrong door’ policy, and will facilitate client access to the services they need, regardless of their eligibility, how they make contact or where they are located.

3.7. Open Arms balances the rights and needs of both parents and children when delivering assessment and intervention to minors (refer to the Services to Minors Procedure).

4. Evidence-Based Practice

4.1. Open Arms supports evidence-based, best practice assessment, treatment and counselling interventions[5][6], acknowledging the role that the therapeutic relationship also plays in achieving treatment outcomes.

4.2. Open Arms’ requirement for the use of evidence-based approaches aligns with discipline-specific standards of the professional bodies under which our clinical workforce practices, including the Australian Health Practitioner Regulation Agency (AHPRA) and is supported by relevant professional associations such as the Australian Psychological Society (APS), Occupational Therapy Australia (OTAus), Australian College of Mental Health Nurses (ACMHN) and the Australian Association of Social Workers (AASW).

4.3. Clinicians must be able to demonstrate a rationale and framework for all clinical decision making during the counselling process.

4.4. Clinicians may only use models and treatments in which they have been trained and are fully competent, or if they are engaging with regular expert clinical supervision to support practice development.

4.5. An Open Arms clinician or Outreach Program Counsellor (OPC) must have prior approval of the relevant Open Arms Director (or delegate) to use interventions with an Open Arms client outside published best practice guidelines. This must be supported by a documented clinical rationale.

4.6. Open Arms provides a range of additional resources on its website to aid clinicians in selecting the most appropriate course of treatment for any given client.

4.7. The Phoenix Australia Practitioner Support Service is available as a free, nation-wide service providing expert multidisciplinary support and guidance to health practitioners, support organisations, and others working with Australian veterans with mental health problems. The service offers consultations for a full range of clinical issues, and also a range of webinars, e-learning courses, research, and other resources for practitioners:

5. Counselling for Couples and Families

5.1. Open Arms care principles require that care is coordinated to protect individual safety and reduce exposure to risk. This is particularly important and relevant when dealing with couples or family groups where violence is identified or reported. See the Care Coordination Procedure for further information.

5.2. Open Arms provides a range of family inclusive services including couple or relationship counselling, family counselling, family therapy, and parenting programs. All eligible Open Arms clients can access these services. A parental consent form must be completed for all minors before counselling services through Open Arms can commence. See the Services to Minors procedure.

5.3. A conflict of interest may arise if a clinician commences family or couple counselling when there is already a well-established counselling relationship with one member of the couple. Where possible, clients or client groups in these circumstances are seen by another clinician. Where a clinician cannot reasonably avoid having a separate counselling relationship with more than one family member, the clinician consults with an Assistant Director and plan is developed to avoid any conflict of interest or detrimental influence on the relationship with either client. The relevant Open Arms Director (or delegate) may approve variations to this requirement.

5.4. In order to maintain the provisions of the Privacy Act 1988, a separate case number and file are maintained for any separate counselling activity of a person other than the nominated client, which is undertaken to support the nominated client.

5.5. An Open Arms clinician (or a clinician contracted by Open Arms) must have prior approval of the relevant Open Arms Director (or delegate) to use interventions for working with couples outside published best practice guidelines supported by a documented clinical rationale. 

6. Complementary Therapies

6.1. Where a clinician believes a client would benefit from a complementary therapy which is unable to be provided internally by Open Arms, and where there is a cost associated with the  intervention, an Action Brief: Business Case to Fund a Complementary Therapy as an Adjunct to Mental Health Treatment (Template 202-03/T3) must be completed and approved by the National Manager prior to any commitment to fund. Many therapies come under the broad description of ‘complementary’. Some examples include: music therapy and art therapy. These are not considered evidence based therapies, and being evidence-based is not an essential criterion. The business case needs to establish benefit to the client and that there is no other reasonable funding source.  OPCs can access funding for a complementary therapy as an adjunct to mental health treatment by contacting their outreach program regional liaison (for example, Outreach Program Coordinator).

6.2. Approval to employ a complementary therapy as an adjunct to mental health treatment must be noted in the client’s record.

7. Counselling Session Length

7.1. In general, sessions with clients conform to the best practice standard of 50-60 minutes. Exceptions may occur at the discretion of the clinician, for example:

  • the first assessment session.
  • in complex intake sessions.
  • when a client is receiving Exposure Therapy (to a maximum of six sessions per reporting period – refer to the Conduct of 90 Minute Sessions Instruction).
  • for relationship or family counselling.
  • for complex care coordination.
  • in instances of crisis and/or risk escalation to ensure appropriate and adequate safety planning and care coordination. See the Responding to Self-Harm, Suicidal and Violent Behaviours Procedure for additional information.

7.2. In all cases where a 90 minute session is carted, the clinical justification for extended sessions should be documented in the case file.

8. Number of Counselling Sessions

8.1. Open Arms employs an episode of care model, with periodic review, for treating and supporting clients. See the Assessment and Care Planning Procedure for further information.

8.2. Sessions for counselling must be approved in advance of the sessions being delivered. The first three sessions for assessment and care planning are approved on allocation.

8.3. The number of sessions that may be approved at one time must not exceed 12 (noting that for Defence referred clients, the limit is 6-8 sessions – see the Defence Referrals Procedure), except as approved by an Assistant Director (or delegate) after a case review and where there is a sound clinical justification. Approval must be in writing and recorded on the client record.

8.4. There is no limit to the number of sessions in an episode of care, but it is required that goals of care are reviewed with the client at regular intervals and that clinical efficacy can be demonstrated through measurement of progress and outcomes. Information on case review and closure is provided in the Clinical Assessment and Treatment Planning Procedure.

9. Frequency of Counselling Sessions

9.1. Within an episode of care, sessions are generally conducted not more than once per week and not less than once per month. In most cases, sessions are weekly, fortnightly, or a combination of both, noting there may be periods where clients require more intensive support during periods of acute illness or crisis.

9.2. Client sessions of more than once per week require the approval of an Assistant Director, based on a sound clinical justification, and for a limited number of sessions. The rationale and approval is to be noted in the client’s file.

9.3. Providing existing clients urgent appointments should take into account risk considerations, details of their Care Plan, and have a sound clinical rationale.

10. Including Significant Others in Individual Counselling

10.1. Decisions regarding the inclusion of significant others, including carers, in individual counselling are encouraged as part of holistic client care, and are based on the professional judgement of the clinician in consultation with the client.

10.2. The clinical rationale for the inclusion of a third party in treatment and the consent of the client in this regard is to be documented in clinical notes, and updated in the client’s consent form.

11. Telehealth

11.1. Both centre-based and OPCs may provide remote counselling including by phone, videoconference or online video-counselling (OVC) to clients unable to attend a centre or a counsellor’s rooms, or who express a preference for remote counselling.

11.2.Only OVC platforms authorised for use by Open Arms are to be used to provide support services to Open Arms Clients. 

11.3. The Online Video Counselling and Support Instruction provides additional guidance on remote counselling.

11.4. Overseas counselling must be approved by the relevant Open Arms Director (or delegate). This does not apply to crisis assistance to a person overseas, which should be addressed on a case-by-case basis to support a client at risk.

11.5. Self-referred clients who are current serving ADF members need to be aware of their security clearance and any considerations relating to remote counselling.

11.6. The use of online platforms and phone consults are available for all Open Arms counselling services (including Agreement for Services between DVA and Defence referrals), pending clinical assessment and appropriateness.

12. After-Hours Counselling

12.1. Open Arms may offer face to face counselling sessions outside business hours with the approval of the relevant Open Arms Director (or delegate). Refer to the Flexible Delivery Procedure.

12.2. OPCs are encouraged to make counselling sessions available after hours, including weekends, as this assist Open Arms to provide a more flexible service.

12.3. Open Arms 24/7 Client Assist also provides after-hours telephone support and crisis assistance.

13. Non-attendance and Follow Up of Clients

13.1. Clients should be advised during their initial session (or at intake) of the need to notify Open Arms if they are unable to attend counselling. This information is also contained in the brochure on client rights and responsibilities.

13.2. At least one follow up attempt should be made for all clients after a missed appointment, in conjunction with a text message (subject to client permissions). A decision on whether to follow up further needs to consider potential risks faced by the client.

13.3.If a client has missed two successive appointments for the same kind of service (i.e., two consecutive sessions of any type) without a sound reason, or cannot be contacted after the second missed appointment, the episode of care should be closed, and the client informed of this by telephone message and written correspondence (email or letter). Before this occurs, in the case of outreach providers, the OPC should contact the Outreach Program Regional Liaison for advice and approval.

13.4. See the Clinical Risk Management Policy for further guidance regarding client disengagement.

14. Terminating a Counselling Session

14.1. Clinicians must not engage in counselling with clients who:

  • are excessively affected by alcohol or drugs.
  • suffer from mental disturbance that limits their capacity to engage in counselling.
  • act in an aggressive or threatening manner.

14.2. In these instances, the clinician uses appropriate safety responses, including referral to suitable treatment alternatives or referral to welfare or social support services. Clinicians are entitled to terminate a counselling session and ask affected clients to leave the premises, providing this is consistent with their duty of care. See the Assessing and Responding to Occupational Violence Procedure for additional guidance.

15. Clinical Records

15.1. A note of every counselling session and significant related actions must be recorded by the clinician and kept in VERA, which is an electronic clinical record.

15.2. Clinical notes must be created, in VERA, for every session conducted with a client, in accordance with the Completion of Clinical Notes Instruction. The purpose of the clinical record is to record client presentation, client progress, any plans for future treatment and the intervention(s) provided each session. Notes should also include the client’s response to interventions provided, including any symptom exacerbation or alleviation. Clinical notes are not intended to be a detailed record of everything discussed in a session.

16. Handover of Clients

16.1. When a clinician takes significant[7] leave or resigns, the clinician must:

  • institute alternative counselling arrangements in consultation with an Assistant Director.
  • provide clients with as much notice as possible; especially those that may have an adverse reaction.
  • ensure the case file and VERA are up-to-date and wherever possible provide a verbal handover.

16.2. When a clinician is on leave, a stand-in clinician is arranged with the intention to provide a continuation of existing treatment strategies, providing a holding function or monitoring risk and keeping the client engaged with the counselling process. A new treatment direction does not normally occur without consultation with an Assistant Director.

16.3. Where a client is being transferred for any period of time to a new clinician, including during the Christmas period, a risk assessment must be undertaken with a safety plan put in place for the period.

16.4. There is no requirement for a new intake to be undertaken if the transfer to another clinician is for a period of less than three months and is within the same episode of care.

16.5. Clients are to be advised of their handover to another clinician verbally by their primary clinician. Where extra-ordinary circumstances exist that prevent the primary clinician from doing so, this is to be done by that clinician’s overseeing Assistant Director or delegate. 

17. Client Satisfaction Survey

17.1. Within two weeks of service file closure, the client satisfaction questionnaire will be emailed to the client via VERA for clients who have consented to receive information digitally.  For clients who have declined to receive information digitally, the client satisfaction questionnaire will be posted along with a cover letter anda business reply paid envelope addressed to Open Arms National Operations. The purpose is to seek feedback from clients as to their experience with counselling and the service. 

17.2. Exception: Consideration is given to the safety and privacy of the client before a questionnaire survey is posted or emailed. For example, a client’s partner may not be aware of the counselling process. Any risk or other concerns should be documented on the client’s individual profile and within the service file and no survey posted.

18. Counselling for Current Serving Members

18.1. Open Arms works collaboratively with the ADF to provide counselling to current serving members.

18.2. Refer to the Defence Referrals Procedure for more detailed information on referral, care provisions and reporting and requirements.

19. Provision of Care to those who use violence against others

19.1. Open Arms manages disclosures of Family and Domestic Violence (FDV) as potential criminal offences and reports this information in accordance with ethical and jurisdictional requirements.

19.2.The provision of rehabilitation programs for those who use violence, including sex offender treatment programs, are the responsibility of state and territory authorities, not of Open Arms.

19.3. Where an appropriate service is not reasonably available, and an Open Arms clinician with relevant training and experience in offender counselling is available and willing to provide such support, Open Arms may provide offender counselling on the basis that it is not a standard Open Arms service. This needs to be approved in writing by the  National Manager (or delegate).

20. Assistance Animals

20.1. Open Arms supports the use of assistance animals for service users with conditions including sight impairment, hearing impairment, mental health and post trauma conditions, and will permit assistance animals, as described by the Disability Discrimination Act 1992, entry to Open Arms premises including offices  and group program locations. 

20.2. Where requested, clients are obliged under the Disability Discrimination Act 1992 to produce evidence that the assistance animal is a legitimately trained and registered service animal.

20.3. The relevant Open Arms Director may withdraw approval for the presence of an assistance animal, where the behaviour of an approved animal becomes distressing or distracting to other service users. Refer to the Assistance Animals Instruction for further detail.

21. Parent Policy

21.1. 202 Open Arms Care Policy

22. Subordinate Instructions and Templates

22.1. 202-03/ 01 Clinical Notes Instruction
22.2. 202-03/ 02 Online Video Counselling and Support Instruction
22.3. 202-03/ 03 Assistance Animals Instruction
22.4. 202-03/ 04 Approval of 90 Minute Sessions Instruction
22.5. 202-03/ T1 Online Video Counselling and Support Consent
22.6. 202-03/ T2 Online Video Counselling and Support Client Information
22.7. 202-03/ T3 Action Brief - Therapy Business Case
22.8. 202-03/ T4 Open Arms Assistance Animals Guidelines
22.9. 202-03/ T5 Client Questionnaire - Counselling [DVA Form]
22.10. 202-03/ T6 Online Video Counselling and Support Checklist





[5] Based on Australian Psychological Society (2018) Interventions in the Treatment of Mental Disorder: A Review of the Literature (4th Edition).

[6] Phoenix Australia - Centre for Posttraumatic Mental Health (2013). Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder. PA-CPMH, Melbourne.

[7] The length of leave at which alternative arrangements are necessary may vary, depending on the risk profile of the clinician’s caseload, and should be determined in consultation with an Assistant Director.

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