Pine Grove Behavioral Health and Addiction Services-Research Agreement

I agree to participate in progress monitoring research designed to improve the effectiveness of the treatment I receive during the time I am enrolled at Pine Grove Behavioral Health and Addiction Services (“Pine Grove”). This monitoring will include information about potential mental health conditions, current and previous drug and alcohol use, and satisfaction with treatment. I understand that this monitoring will be conducted by Vista Research Group, Inc. (“Vista”) using online surveys, and that all information I provide while I’m attending this treatment program will be immediately shared with the clinician(s) and/or the leadership of Pine Grove so that it can be used to improve my treatment. I agree that Vista may use email or text messaging to send me links to the surveys as well as a copy of this consent form.

I also agree that Vista may contact me periodically during the first 13 months after I leave Pine Grove to ask me questions about my recovery. This post-treatment outcomes research is designed to help Pine Grove improve the treatment it provides to future clients. Since I am not benefitting directly from this portion of the research, Vista will provide me a small stipend in appreciation for my time.

Vista will keep my post-treatment survey responses confidential unless otherwise required by law or permitted under this agreement. Vista will provide my responses to the leadership of Pine Grove only after Vista deidentifies the information and combines it with the responses of other patients. However, I agree that Vista may notify Pine Grove if I specifically indicate that I am interested in returning to active treatment at Pine Grove.

Additionally, I agree that Vista may contact Pine Grove and appropriate law enforcement agencies if Vista reasonably believes, based on my communications with Vista, that I have made a serious threat to physically harm myself or others. I understand that Vista is NOT my healthcare provider or a crisis line; Vista does not assume any duty to warn or protect me or others from harm.

I give Vista permission to send me links to the surveys, gift cards, and a copy of this agreement by email or text. I also give permission for gift cards and a copy of this agreement to be sent to me through the mail, and for Vista researchers to call me if they are unable to reach me via email or text.

I also agree that Pine Grove may share with Vista my name, medical record number, birthdate, gender, phone number(s), email address, the name and type of my health plan, the name(s) of my primary clinicians, and the dates and reasons why I am admitted, transferred and discharged from Pine Grove’s program(s).

I understand that health information that may be used to identify me is protected under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and 45 C.F.R. Parts 160 and 164. The confidentiality of my health information may also be protected under 42 C.F.R. Part 2. I understand that my personally-identifiable health information and/or substance use disorder records cannot be disclosed without my written consent unless otherwise provided for by federal law or regulation.

I understand that this authorization expires 13 months after I have left Pine Grove, and that I have the right to revoke this authorization at any time by emailing research@vista-research-group.net. I understand that my enrollment at Pine Grove is not contingent upon my involvement in this research.

Finally, if I am a minor, I understand that a parent or guardian will also be asked to agree to my participation in this research, unless state law allows me to consent to treatment on my own and I request that my parent or guardian not be notified.

Do you want to join a community of treatment professionals who are fervently committed to providing every patient with the best possible chance of recovering from addiction and/or mental illness? Members of the Vista Research Network use state-of-the-art software to monitor patients during treatment and follow up with them afterwards to learn how effective their treatment was in helping them recover. Not only are clinicians able to use to easily personalize the treatment they provide, but Vista’s trailblazing data analytics platform and comprehensive research reports help owners and managers continually monitor and improve their center’s effectiveness.

Vista Research Group monitors your patients during treatment and follows up with them afterwards so you can help more of your patients recover from addiction.

Once Vista’s research agreement is signed, a 30-minute Implementation Meeting will be scheduled with your leadership team to understand how your center is structured and what data you want to collect. After this meeting, the only additional information Vista will need is a list of users needing access to the software. Vista is usually able to customize the software for a new center within 24 hours of receiving this patient list.

During online training sessions, Vista will explain why progress monitoring helps patients get better faster, demonstrate the key features of the software, discuss best practices, and answer any questions your team has.

Training videos and step-by-step instructions are available in Vista’s private community as well as in a searchable Knowledge Base. Vista also provides live phone and email support seven days a week to answer any questions new users might have.