Source: https://www.mendability.com/pro/terms-and-conditions-of-use/
Timestamp: 2019-04-20 20:12:05+00:00

Document:
There are THREE agreements below. “Terms and Conditions of Use”, “Mendability Suicide Prevention Mandate”, and “SENSORY ENRICHMENT THERAPY MODALITY AGREEMENT” You must read and agree to all three agreements to take the certification course. You will also be shown these agreements separately and agree to them separately and specifically during the registration of a professional account with Mendability.
AS A REQUIREMENT FOR JOINT COMMISSION CERTIFICATION AND FOR YOUR HEALTH AND SAFETY AND THE HEALTH AND SAFETY OF THOSE WITHIN YOUR CARE, WE ARE REQUIRED TO HELP YOU IDENTIFY SPECIFIC CHARACTERISTICS AND ENVIRONMENTAL FEATURES THAT MAY INCREASE OR DECREASE THE RISK OF SUICIDE AND TO PROVIDE YOU WITH SUICIDE PREVENTION INFORMATION.
BY USING MENDABILITY SERVICES OR THIS SITE YOU AGREE THAT YOU HAVE READ AND UNDERSTOOD THE CONTENTS OF THIS DOCUMENT AND CERTIFY THAT YOU AGREE TO SEEK PROFESSIONAL HELP IF YOU OR ANYONE WITHIN YOUR CARE SHOWS OR DEVELOPS SIGNS OF SUICIDE RISK. YOU FURTHER CERTIFY THAT NEITHER YOU NOR ANY PERSON WITHIN YOUR CARE ON MENDABILITY IS AT RISK FOR SUICIDE.
If after you have read the document you feel unqualified to assess the suicide risk of the individual, you must seek professional help in determining the suicide risk prior to proceeding any further with any interactions on Mendability.
This introduction provides general information regarding the nature and prevalence of suicidal behaviors and factors associated with increased risk for suicide and suicide attempts.
Suicidal thoughts and behaviors (including suicide attempts and death by suicide) are commonly found at increased rates among individuals with psychiatric disorders, especially major depressive disorder, bipolar disorders, schizophrenia, PTSD, anxiety, chemical dependency, and personality disorders (e.g., antisocial and borderline). A history of a suicide attempt is the strongest predictor of future suicide attempts, as well as death by suicide. Intentional self-harm (i.e., intentional self-injury without the expressed intent to die) is also associated with long-term risk for repeated attempts as well as death by suicide.
Psychiatric co-morbidity (greater than one psychiatric disorder present at the same time) increases risk for suicide, especially when substance abuse or depressive symptoms coexist with another psychiatric disorder or condition.
A number of psychosocial factors are also associated with risk for suicide and suicide attempts. These include recent life events such as losses (esp. employment, careers, finances, housing, marital relationships, physical health, and a sense of a future), and chronic or long-term problems such as relationship difficulties, unemployment, and problems with the legal authorities (legal charges). Psychological states of acute or extreme distress (especially humiliation, despair, guilt and shame) are often present in association with suicidal ideation, planning and attempts. While not uniformly predictive of suicidal ideation and behavior, they are warning signs of psychological vulnerability and indicate a need for mental health evaluation to minimize immediate discomfort and to evaluate suicide risk.
Certain physical disorders are associated with an increased risk for suicide including diseases of the central nervous system (epilepsy, tumors, Huntington’s Chorea, Alzheimer’s Disease, Multiple Sclerosis, spinal cord injuries, and traumatic brain injury), cancers (esp. head and neck), autoimmune diseases, renal disease, and HIV/AIDS. Chronic pain syndromes can contribute substantially to increased suicide risk in affected individuals.
Patients with traumatic brain injuries may be at increased risk for suicide. In comparison to the general population TBI survivors are at increased risk for suicide ideation (Simpson and Tate, 2002), suicide attempts (Silver et al. 2001) and suicide completions (Teasdale and Engberg, 2001). TBI-related sequelae can be enduring and may include motor disturbances, sensory deficits, and psychiatric symptoms (such as depression, anxiety, psychosis, and personality changes) as well as cognitive dysfunction. These cognitive impairments include impaired attention, concentration, processing speed, memory, language and communication, problem solving, concept formation, judgment, and initiation. Another important TBI sequelae that contributes to suicidal risk is the frequent increase in impulsivity. These impairments may lead to a life-long increased suicide risk which requires constant attention.
Although relatively rare, suicidal thoughts and behaviors are not uncommonly reported in the general population. A recent national survey (Kessler, et al., 1999) found that 13.5 % of Americans report a history of suicide ideation at some point over the lifetime, 3.9% report having made a suicide plan, and 4.6% report having attempted suicide. Among attempters, about 50% report having made a “serious” attempt. The percentages are higher for high school students asked about suicidal ideation and behavior over the preceding year: 16% report having seriously considered attempting suicide, 13% report having made a suicide plan, and 8.4% report having made an attempt during the prior 12 months (CDC, YRBS 2005). These numbers are even higher when a psychiatric disorder is present.
Often there is a transition that takes place along the continuum from ideation to plan to attempts. 34 % of individuals who think about suicide report transitioning from seriously thinking about suicide to making a plan, and 72% of planners move from a plan to an attempt. Among those who make attempts, 60% of planned attempts occur within the first year of ideation onset and 90% of unplanned attempts (which probably represent impulsive self-injurious behaviors) occur within this time period (Kessler, et al., 1999). These findings illustrate the importance of eliciting and exploring suicidal ideation and give credence to its role in initiating and fueling the suicidal process.
What are warning signs and why are they important?
There are a number of known suicide risk factors. Nevertheless, these risk factors are not necessarily closely related in time to the onset of suicidal behaviors – nor does any risk factor alone increase or decrease risk. Population-based research suggests that the risk for suicide increases with an increase in the number of risk factors present, such that when more risk factors are present at any one time the more likely that they indicate an increased risk for suicidal behaviors at that time.
A recent review of the world’s literature has identified a number of warning signs that empirically have been shown to be temporally related to the acute onset of suicidal behaviors (e.g., within hours to a few days). These signs should warn you of ACUTE risk for the expression of suicidal behaviors, especially in those individuals with other risk factors (Rudd, et al., 2006). Three of these warning signs carry the highest likelihood of short-term onset of suicidal behaviors and require immediate attention, evaluation, referral, or consideration of hospitalization.
The remaining list of warning signs should alert you that a mental health evaluation needs to be conducted in the VERY near future and that precautions need to be put into place IMMEDIATELY to ensure the safety, stability and security of the individual.
Other behaviors that may be associated with increased short-term risk for suicide are when the patient makes arrangements to divest responsibility for dependent others (children, pets, elders), or making other preparations such as updating wills, making financial arrangements for paying bills, saying goodbye to loved ones, etc.
Factors that may increase risk or factors that may decrease risk are those that have been found to be statistically related to the presence or absence of suicidal behaviors. They do not necessarily impart a causal relationship. Rather they serve as guidelines for you to weigh the relative risk of an individual engaging in suicidal behaviors within the context of the current clinical presentation and psychosocial setting. Individuals differ in the degree to which risk and protective factors affect their propensity for engaging in suicidal behaviors. Within an individual, the contribution of each risk and protective factor to their suicidality will vary over the course of their lives.
No one risk factor, or set of risk factors, necessarily conveys increased suicidal risk. Nor does one protective factor, or set of protective factors, insure protection against engagement in suicidal behaviors. Furthermore, because of their different statistical correlations with suicidal behaviors, these factors are not equal and one cannot “balance” one set of factors against another in order to derive a sum total score of relative suicidal risk. Some risk factors are immutable (e.g., age, gender, race/ethnicity), while others are more situation-specific (e.g., loss of housing, exacerbation of pain in a chronic condition, and onset or exacerbation of psychiatric symptoms).
Ideally, with the elucidation and knowledge of an individual’s risk and protective factors as a backdrop, you will inquire about the individual’s reasons for living and reasons for dying to better evaluate current risk for suicide.
Asking questions about suicidal ideation, intent, plan, and attempts is not easy. Sometimes the individual will provide the opening to ask about suicide, but usually the topic does not readily flow from the presenting complaint and gathering of history related to the present illness. This can be particularly true in medical as opposed to behavioral health type settings. Nevertheless it is important to ask a screening set of questions whenever the clinical situation or presentation warrants it. The key is to set the stage for the questions and to signal to the individual that they are naturally part of the overall assessment of the current problem. A great deal depends upon your familiarity with the key screening questions and the ease and comfortableness he/she has with the topic and the asking of the questions. Introductory statements that lead into the questions pave the way to ensuring an informative and smooth dialogue and reassure the individual that you are prepared for and interested in the answers.
I appreciate how difficult this problem must be for you at this time. Some people with similar problems/symptoms have expressed that they have thought about ending their life. I wonder if you have had similar thoughts?
It is worth keeping in mind that suicidality can be understood as an attempt by the individual to solve a problem, one that they find overwhelming. It can be much easier for you to be nonjudgmental when s/he keeps this perspective in mind. You can work with Professionals in this area that can help find solutions to these problems.
Why is it important to ask about a history of attempts?
Most people who attempt suicide do not attempt again. However, about 16% repeat within one year and 21% repeat within 1-4 years. (Owens et al., 2002: Beautrais, 2003). The majority of repeat attempters will use more lethal means on subsequent attempts – increasing the likelihood of increased morbidity or mortality. Approximately 2% of attempters die by suicide within 1 year of their attempt. The history of a prior suicide attempt is the best known predictor for future suicidal behaviors, including death by suicide. Approximately 8-10% of attempters will eventually die by suicide.
Why is it important to ask about feeling hopeless?
Hopelessness – about the present and the future – has been found to be a very strong predictor of suicidal ideation and self-destructive behaviors. Associated with hopelessness are feelings of helplessness, worthlessness, and despair. Although often found in depressed patients, these affective states can be present in many disorders – both psychiatric and physical. If present it is important to explore these feelings with the individual to better assess for the development or expression of suicidal behaviors.
Why is it important to ask about ideation?
In most cases, suicidal ideation is believed to precede the onset of suicidal planning and action. Suicidal ideation can be associated with a desire or wish to die (intent) and a reason or rationale for wanting to die (motivation). Hence, it is essential to explore the presence or absence of ideation – currently, in the recent past, and concurrent with any change in physical health or other major psychosocial life stress.
Many individuals will initially deny the presence of suicidal ideation for a variety of reasons including: 1. the stigma that is associated with acknowledging symptoms of a mental disorder; 2. fear of being ridiculed, maligned and/or being judged negatively by yourself; 3. loss of autonomy and control over the situation; and 4. fear that you might overreact and hospitalize the individual involuntarily.
Even if denied, certain observable cues (affective and behavioral) should prompt you to remain alert to the possible presence of suicidal ideation. Some signs and symptoms include: profound social withdrawal, irrational thinking, paranoia, global insomnia, depressed affect, agitation, anxiety, irritability, despair, shame, humiliation, disgrace, anger and rage. You may find an apparent disparity between the current observable condition (what is seen and felt by the individual) and a denial of suicidal thinking on the part of the individual. This will be a good indicator of the need still to seek professional advice regarding the situation.
Asking about suicidal ideation and intent does not increase the likelihood of someone thinking about suicide for the first time or engaging in such behaviors. In fact, most patients report a sense of relief and support when a caring, concerned caregiver non-judgmentally expresses interest in exploring and understanding the individual’s current psychological pain and distress that leads them to consider suicide or other self-injurious behaviors.
All suicidal ideations and suicidal threats need to be taken seriously.
Why is it important to ask about timing of ideation and presence of a plan?
Although a minority of individuals are chronically suicidal, most people become suicidal in response to negative life events or psychosocial stressors that overwhelm their capacity to cope and maintain control, especially in the presence of a psychiatric disorder. Hence it is important to understand what elicits suicidal thoughts and the context of these thoughts. Knowing how much time has been spent thinking about suicide alerts you to its role and influence in the daily life of the individual. Knowing what makes things better and what makes things worse regarding the onset, intensity, duration and frequency of suicidal thoughts and feelings assists the Professional in developing a treatment plan. Also knowing what situations in the future might engender the return of suicidal thoughts helps you and the Professional, along with the individual to agree upon a safety plan and techniques to avoid or manage such situations.
The presence of a suicide plan set out by the Professional indicates that the individual has some intent to die and has begun preparing to die. It is important to know the possibilities and potential for implementation of the plan, the likelihood of being rescued if the plan is undertaken, and the relative lethality of the plan.
Although some research suggests a relationship between the degree of suicidal intent and the lethality of the means, you should not dismiss the presence of suicidal planning even if the method chosen does not appear to be necessarily lethal (Brown, et al., 2004). It is also important to know whether the individual has begun to enact the plan, by engaging in such behaviors as rehearsals, hoarding of medications, gaining access to firearms or other lethal means, writing a suicide note, etc.
A crisis is when the individual’s usual and customary coping skills are no longer adequate to address a perceived stressful situation. Often such situations are novel and unexpected. A crisis occurs when unusual stress, brought on by unexpected and disruptive events, render an individual physically and emotionally disabled – because their usual coping mechanisms and past behavioral repertoire prove ineffective. A crisis overrides an individual’s normal psychological and biological coping mechanisms – moving the individual towards maladaptive behaviors. A crisis limits one’s ability to utilize more cognitively sophisticated problem-solving skills and conflict resolution skills. Crises are, by definition, time-limited. However, every crisis is a high risk situation.
In a crisis, seek Professional help immediately and if necessary call 911 or the Suicide Prevention Lifeline number 1-800-273-8255. The goals of crisis intervention are to lessen the intensity, duration, and presence of a crisis that is perceived as overwhelming and that can lead to self-injurious behaviors. This is accomplished along with the Professional by shifting the focus from an emergency that is life-threatening to a plan of action that is understandable and perceived as doable. The goal is to protect the individual from self-harm. In the process, it is critical for the Professional with your help to identify and discuss the underlying disorder, dysfunction, and/or event that precipitated the crisis. Involving family, partners, friends, and social support networks may be advised by the Professional.
The objectives of the Professional are to assist the individual in regaining mastery, control, and predictability. This is accomplished by reinforcing healthy coping skills and substituting more effective skills and responses for less effective skills and dysfunctional responses. The goal of crisis management is to re-establish equilibrium and restore the individual to a state of feeling in control in a safe, secure, and stable environment. Under certain circumstances this might require hospitalization. Professionals are especially equipped and trained to manage the crisis and make the call. Do not attempt to manage the crisis on your own.
The techniques the professional may employ or offer include removing or securing any lethal methods of self-harm, decreasing isolation, decreasing anxiety and agitation, and engaging the individual in a safety plan (crisis management or contingency planning). It also involves a simple set of reminders for the individual to utilize the crisis safety plan and skills agreed upon by you, the professional, and the individual.
Any reference to suicidal ideation, intent, or plans mandates a mental health assessment. If the individual is deemed by a professional not to be at immediate risk for engaging in self-destructive behaviors, then the Professional needs to collaboratively develop a follow-up and follow-through plan of action. This activity best involves the individual along with significant others such as family members, friends, spouse, partner, close friends, etc.).
Don’t dare him/her to engage in suicidal behaviors.
Offer hope that alternatives are available – but don’t offer reassurances that any one alternative will turn things around in the near future.
Be actively involved in encouraging the person to see a mental health professional as soon as possible and ensure that an appointment is made.
Individuals contemplating suicide often don’t believe that they can be helped, so you may have to be active and persistent in helping them to get the help they need. And, after helping an individual during a mental health crisis, be aware of how you may have been affected emotionally and seek the necessary support for yourself.
Myth: Asking about suicide would plant the idea in my patient’s head.
Myth: There are talkers and there are doers.
Reality: Most people who die by suicide have communicated some intent. Someone who talks about suicide gives the physician an opportunity to intervene before suicidal behaviors occur.
Reality: Most suicidal ideas are associated with the presence of underlying treatable disorders. Providing a safe environment for treatment of the underlying cause can save lives. The acute risk for suicide is often time-limited. If you can help the person survive the immediate crisis and the strong intent to die by suicide, then you will have gone a long way towards promoting a positive outcome.
Myth: He/she really wouldn’t kill themselves since ______.
Reality: The intent to die can override any rational thinking. In the presence of suicidal ideation or intent, you should not be dissuaded from thinking that the patient is capable of acting on these thoughts and feelings. No Harm or No Suicide contracts have been shown to be essentially worthless from a clinical and management perspective. The anecdotal reports of their usefulness can all be explained by the strength of the alliance with the care provider that results from such a collaborative exchange, not from the specifics of the contract itself.
Reality: Suicide “gestures” require thoughtful assessment and treatment. Multiple prior suicide attempts increase the likelihood of eventually dying by suicide. The task is to empathically and non-judgmentally engage the individual in understanding the behavior and finding safer and healthier ways of asking for help. Seek Professional help in this.
American Psychiatric Association. (2004). Practice Guidelines for the Assessment and Treatment of Patients with Suicidal Behaviors. In: Practice Guidelines for the Treatment of Psychiatric Disorders Compendium, 2nd edition. pp. 835-1027. VA: Arlington.
Beautrais, A.L. (2003). Subsequent mortality in medically serious suicide attempts: A 5 year follow-up. Australian and New Zealand Journal of Psychiatry; 37: 595-599.
Brown, G.K., Henriques, G.R., Sosdjan, D., & Beck, A.T. (2004). Suicide intent and accurate expectations of lethality: Predictors of medical lethality of suicide attempts. Journal of Consulting and Clinical Psychology; 72, 1170-1174.
CDC. Youth Risk Behavior Survey, (2005). Morbidity and Mortality Weekly, Surveillance Summaries, Volume 55, No. SS-5 (June 6, 2006), 1-108.
Kessler, R.C., Borges, B., & Walters, E.E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry; 56, 617-626.
Owens, D., Horrocks, J., & House, A. (2002). Fatal and non-fatal repetition of self-harm. Systematic review. British Journal of Psychiatry; 181, 193-199.
Rudd M.D., Berman, A.L., Joiner, T.E., Nock, M.K., Silverman, M.M., Mandrusiak, M., Van Orden, K., & Witte, T. (2006) Warning signs for suicide: Theory, research and clinical applications. Suicide and Life Threatening Behavior; 36, 255-62.
Silver, J.M., Kramer, R., Greenwald, S., Weissman, M. (2001). The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiological Catchment Area Study. Brain Injury, 15, 11, 935-945.
Simpson, G. & Tate, R. (2002). Suicidality after traumatic brain injury: demographic, injury and clinical correlates. Psychological Medicine, 32, 687-697.
Teasdale, T.W. & Engberg, A.W. (2001). Suicide after traumatic brain injury: A population study. The Journal of Neurology, Neurosurgery, and Psychiatry, 71 (4), 436-440.
Berman, A.L., Jobes, D.A. & Silverman, M.M. (2006) Adolescent Suicide: Assessment and Intervention. NY: Guilford Publications.
Brown, G., Ten Have, T., Henriques, G., Xie, S., Hollander, J. & Beck, A. (2005). Cognitive Therapy for the Prevention of Suicide Attempts, A Randomized Controlled Trial. JAMA, 294(5). 563-570.
Institute of Medicine. (2002) Reducing Suicide: A National Imperative. Washington DC; The National Academies Press.
Jacobs, D.G. (Ed.) (1999). The Harvard Medical School Guide to Suicide Assessment and Intervention. San Francisco, CA: Jossey-Bass.
Jacobs, D. & Brewer, M (2004). American Psychiatric Association practice guidelines provides recommendations for assessing and treating patient with suicidal behaviors. Psychiatric Annals, 34 (5), 373-380.
Jobes, David A., (2006) Managing Suicidal Risk: A Collaborative Approach. New York, NY: The Guilford Press.
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Rudd, M.D. (2006) The Assessment and Management of Suicidality. Sarasota, FL: Professional Resource Press.
Shea, S. (2002). The Practical Art of Suicide Assessment: A Guide for Mental Health Professional and Substance Abuse Counselors. Hoboken, NJ: John Wiley & Sons.
Shea, S. (2004) The Delicate Art of Eliciting Suicidal Ideation. Psychiatric Annals, 34 (5), 374-400.
Shneidman, E.S. (2004). Autopsy of a Suicidal Mind. London, Oxford University Press.
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Simon, R.I. (2004). Assessing and Managing Suicide Risk: Guidelines for Clinically Based Risk Management. Washington DC: American Psychiatric Publishing, Inc.
Simon, R. & Hales, R. (2006). Textbook of Suicide Assessment and Management. Arlington, VA: American Psychiatric Publishing, Inc.
THIS SENSORY ENRICHMENT THERAPY MODALITY AGREEMENT (“Agreement“) is entered into effective as of the date of digital signature of acceptance by Therapist (“Effective Date“), by and between Mendability LLC., a Utah Limited Liability Corporation, located at 12 W 100 N, Ste 201E, American Fork UT, 84003 (“Company” or “Mendability“) and the undersigned (“Therapist”). The Company and Therapist may collectively be referred to hereafter as the “Parties” or each, individually, as a “Party“.
Definitions. All capitalized terms used in this Agreement shall have the defined meanings ascribed to them herein, and cognate terms have, respectively, corresponding meanings.
License. During the Term and subject to the Pre-License Conditions set forth in Section 3 below and the License Restrictions set forth in Section 5 below, Company hereby grants to Therapist a nonexclusive, non-transferrable, revocable, limited license (the “License”) to use the Company Confidential Information, for the sole purpose of providing patients with those services expressly prescribed in the Therapy Modality Materials, as applicable (“Therapy Services“); provided, however, that the parties hereto acknowledge that a condition precedent to the use of the License is that Therapist have at least one (1) active subscription in good standing and that each patient served by Therapist have an active subscription in good standing on the Mendability therapy application website. If at any time Therapist fails to maintain at least one (1) active subscription in good standing and fails to maintain, for each patient served by Therapist, an active subscription in good standing on the Mendability therapy application website, the License shall immediately and automatically lapse and this Agreement shall thereafter be terminated. The License shall specifically include (without limitation) the right to use the “Therapy Modality Patents”, the “Therapy Modality Trademarks”, the “Therapy Modality Copyrights” and the “Therapy Modality Materials” – all as defined below. All rights not expressly included in the foregoing License are expressly reserved by Company.
“); provided, however, that Therapist shall submit samples of any such materials to Company for Company’s review and approval, which shall not be unreasonably withheld, before such materials are made available to any third party.
Improvements. All improvements to the Company Confidential Information (“Improvements“) shall be the sole property of Company, regardless of the identity of the maker of the Improvements.
No Other Rights. The License granted hereunder shall not be construed to confer any rights upon Therapist by implication, estoppel or otherwise.
Sublicenses. Therapist shall have no right to grant sublicenses of its rights under the License without the consent of Company.
Pre-License Conditions. Therapist shall maintain, at all times during the Term, either a Temporary Provisional Certification or a Sensory Enrichment Therapy Practitioner Certification, both as defined below. If Therapist fails to maintain at least one such certification at any time during the Term, the License shall expire and this Agreement shall be terminated.
Workshop Attendance. Therapist shall attend a complete Therapy Modality certification training workshop as required by the Company (“Workshop“) (an up-to-date list of Workshop dates is identified on Company’s website at https://www.mendability.com/sensory-enrichment-therapy-certification/). In connection with the Training, the Therapist will be provided with access to those documents and materials that comprise the “Therapy Modality Materials”, as defined below.
Payment of Fees. Therapist shall pay all applicable Therapy Modality certification fees at the time of registration at the fee advertised at the time of registration (which fees are identified on Company’s website at https://www.mendability.com/sensory-enrichment-therapy-certification/).
As soon as Therapist has attended the Workshop as required under Section 3(a)(i), has passed the Therapy Modality certification exam described in Section 3(a)(ii) and has paid all applicable fees set forth in Section 3(a)(iii), the Company shall provide a written certificate acknowledging that Therapist has been certified by Company to provide the Therapy Modality under a Temporary Provisional Certification (the “Temporary Certification“), which will allow Therapist to use the License, so long as such Temporary Provisional Certification has not lapsed or this Agreement has not been otherwise terminated.
Receipt of Temporary Provisional Certification. Therapist shall have an active valid Temporary Provisional Certification (as outlined in Section 3.a. above).
Practicum. Therapist shall comply with all of the practicum requirements before the end of the practicum period (“Practicum Period“) (the practicum requirements and practicum period are identified on the Company’s website at https://www.mendability.com/sensory-enrichment-therapy-certification/).
Once Therapist has evidenced possession of an active Temporary Provisional Certification and has passed the practicum requirements, Company shall provide a written certificate acknowledging that Therapist has been certified by Company to provide the Therapy Modality with title of “Sensory Enrichment Therapy Practitioner” (the “Certification“) The Certification will allow Therapist to continue use of the License until this Agreement is terminated.
Renewal and Revocation. Therapist acknowledges and agrees that the Temporary Certification shall automatically expire on the date printed on the Temporary Certification. Therapist further acknowledges and agrees Certification by Company shall automatically expire after two (2) years and that Therapist will be required to comply with the requirements published by Company in order to renew such Certification (hereafter, a “Certificate Renewal”), which requirements may include, without limitation, completion of any required renewal certification workshops, passage of any applicable renewal exams, and payment of any applicable renewal fees including Workshop fees and recurring subscription fees. Company may revoke Therapist’s Certification at any time in Company’s reasonable discretion by providing written notice thereof to Therapist at which time this Agreement shall terminate and the license granted to Therapist herein shall be revoked.
License Restrictions. Notwithstanding anything to the contrary in this Agreement, the License shall not include any of the following: (i) the deliverance of the Therapy Services, or disclosure of any part of the Therapy Services, via any means other than during support of a current client, which prohibition includes, without limitation, posting any audio or video materials comprising Therapy Services on a website, disclosing the Therapy Services or any part thereof to more than one person at a time or to anyone other than a patient or the patient’s caregiver, or providing the online therapy services except as expressly authorized by Company unless Therapist requests and obtains in each case, Company’s prior written consent, which may be withheld in Company’s absolute discretion; (ii) the provision of instruction, teaching or training to any other person using any Company Confidential Information, which provision includes, without limitation, disclosing any Confidential Information related to the Therapy Services to anyone other than as expressly permitted in Section 4(d); (iii) the capture (through photograph, video or audio record, or otherwise) of any audio or image of any Training, Workshops, Therapy Modality, Therapy Modality Materials, or any Therapy Services, including without limitation by using video cameras, cellular telephones, tape recorders, or other technologies capable of capturing audio, video, images, or text; (iv) the violation of the Company’s policy on reproduction or production of videos or other media, copy or reproduce any of the Therapy Modality Materials or making of any of the Therapy Modality Materials accessible to any person except as expressly permitted pursuant to Section 6(d); (v) the modification, reverse engineering, or creation of any derivative works based on any Company Confidential Information, or any part thereof, or use or disclose of any modified form of any Company Confidential Information, which prohibition includes, among other things, creating, disclosing or using any modified form of Therapy Modality in connection with Therapist’s provision of Therapy Services, unless Therapist requests and obtains, in each case, Company’s prior written consent, which may be withheld in Company’s absolute discretion; (vi) the use of the Therapy Modality Trademarks or any part thereof, in any form, for any goods or services except as expressly permitted hereunder, which prohibition includes, without limitation, any use of any Therapy Modality Materials on or in connection with information delivered via webcam, telephone, video conference, software program, online video or streaming, or via any alternative or other technical means, whether now known or hereafter devised anything, other than use on the Approved Therapist Materials and Approved Informational Materials (defined below); (vii) the right to represent that the Company Confidential Information, or any part thereof, is owned by Therapist or any third party; (viii) the right to remove any proprietary notices, labels, marks or identifying information of any kind on the Therapy Modality Materials or any other documents or materials that Company provides or makes available to Therapist; and (ix) the use of any Company Confidential Information, or any part thereof, for any purpose other than in accordance with the terms and conditions of this Agreement; (x) the right to use the license if Therapist has violated any law, statute, code, regulation, rule, ordinance, order, judgment or decree of any United States or foreign country, state, province, municipality, county or other government court, agency, instrumentality or jurisdiction, including, without limitation, the Health Insurance Portability and Accountability Act of 1996, as amended from time to time, and the regulation promulgated thereunder, including 45 C.F.R. Parts 160 and 164, as amended or supplemented from time to time (collectively, “Laws“).
Confidentiality and Nondisclosure of Company Confidential Information.
Ownership of Company Confidential Information. Therapist acknowledges and agrees that Company is the owner of all of the Company Confidential Information, including, without limitation, the Therapy Modality, business and marketing plans and other information regarding operation of Company; financial information, fee structure, compensation and other related information; data, databases, documents, files, electronically recorded information, books, papers, records, specifications, compilations of information and other related information; computer programs, software, spreadsheets, programming, software specifications, and other information and materials relating to computer software; equipment, computing systems, hardware, devices, apparatus, technology and systems integration and technical information; research and development information, trade secrets, know-how, methods, studies, and other Inventions; other information and materials disclosed in confidence to Therapist, directly or indirectly, either orally or in writing, by Company; and any derivative works, improvements or modifications to any of the foregoing, and any other information or materials created, in whole or in part, by using any of the foregoing. Therapist acknowledges and agrees that information need not be labelled as “confidential” to qualify as Confidential Information.
Exclusions. Company Confidential Information does not include information that Therapist can demonstrate: (a) is now or hereafter becomes, through no act or failure to act on the part of Therapist, generally known or widely available to the public; (b) was known by Therapist prior to receiving such information or materials from Company; or (c) is independently developed by Therapist without using, incorporating, referencing, recreating or relying upon any of the Confidential Information. Notwithstanding the foregoing, Therapist acknowledges and agrees that Company’s compilation of information, as disclosed to Therapist, constitutes confidential information under this Agreement even though portions of such information may be individually disclosed or found in the public domain.
Nondisclosure and Nonuse of Company Confidential Information. During the Term of this Agreement, Therapist will have access to and be provided with Company Confidential Information. Therapist represents, warrants and agrees that: (i) Therapist will not use any such Company Confidential Information during the Term of this Agreement, except as otherwise expressly permitted by the License; (ii) Therapist will not use any Company Confidential Information for any purpose following the termination of this Agreement, except only to the extent necessary to determine the scope of Therapy Services that were previously provided to a patient during the Term of this Agreement; and (iii) except as otherwise expressly provided in Section 6(d), Therapist will not at any time, either during or after the Term of this Agreement, disclose or make available to any third party, any Company Confidential Information, unless Therapist requests and obtains, in each case, Company’s prior written consent, which may be withheld in Company’s absolute discretion. Without limiting the generality of the foregoing, Therapist may not post on the Internet or otherwise publicly disclose any videos or other materials related to Therapy Modality that would enable or assist in the performance of any of Company’s proprietary protocols or exercises. Therapist agrees to provide written notice to the Company immediately of any actual or suspected disclosure to or use by any third party of any Company Confidential Information of which Therapist gains knowledge while engaged by Company.
Permitted Disclosure. Notwithstanding Section 6(c), during the Term of this Agreement, Therapist may disclose Approved Informational Materials to doctors, clinicians, medical professionals, researchers, patients and prospective patients only as expressly permitted in writing by Company. For purposes of this Agreement, “Approved Informational Materials” means any Therapy Modality Materials that Company has expressly authorized in writing for disclosure pursuant to this Section, including Therapy Modality and the Company marketing brochures that provide information about Therapy Modality and the Company to individuals and caregivers of individuals with ASD and other neurological conditions. Subject to the other restrictions set forth herein, Therapist may also disclose individual portions of the Company Confidential Information (in addition to the Approved Informational Materials) to the extent that such disclosure is reasonably necessary to render the Therapy Services. In addition, Therapists employed as faculty and clinical supervisors of accredited higher education institutions providing formal (e.g., ASHA approved) degree programs related to speech or voice therapy and physical/occupational therapy may disclose Approved Information Materials in connection with the Therapist’s formal academic capacities. Approved Informational Materials may be copied and provided to such patients, prospective patients, or higher education students, as applicable; provided, however, that all such documents must bear the following copyright notice: “Copyright 2016 Mendability LLC. All rights reserved.” If the year of creation or first publication of the work, whichever is earlier, is different from 2016, then Therapist must substitute the applicable year in the notice. Therapist may not create, use or disclose any modified version or derivative works of the Approved Informational Materials, nor may Therapist disclose any Approved Information Materials or other the Company Confidential Information to any third party except as expressly permitted by this Section. If Therapist has a website that advertises therapy services, Therapist shall disclose on said website the certification that is held as “Sensory Enrichment Therapy (Therapy Modality) Certified”.
Ownership of Inventions and Improvements.
Ownership of Inventions. Therapist agrees that all right, title, and interest in and to any and all original works of authorship, developments, concepts, improvements, designs, discoveries, inventions, ideas, trademarks or trade secrets, whether or not patentable or registrable under copyright or similar laws (collectively referred to as “Inventions“), which Therapist may solely or jointly conceive or develop or reduce to practice, or cause to be conceived or developed or reduced to practice, during the Term of this Agreement shall be and are hereby assigned to the Company or its designee, except for any Inventions which: (1) Therapist developed entirely on its own time without using the Company’s equipment, supplies, facilities, or the Company Confidential Information; (2) are unrelated to the Company’s business; and (3) do not result from any Therapy Services performed pursuant to this Agreement.
Ownership of Improvements. Therapist acknowledges and agrees that, as between Therapist and Company, Company shall be the sole owner of all of the “Improvements” (as defined in Section 2(c) above). This Agreement grants a license only and transfers to Therapist no ownership interest in any Company Confidential Information nor any Improvements. Therapist shall not take any action to jeopardize, limit or interfere in any manner with Company’s ownership of and rights with respect to the Company Confidential Information. Therapist acknowledges that all goodwill arising out of the use of the Therapy Modality Trademarks will inure to the exclusive benefit of the Company. All rights, other than the license rights expressly granted in Section 2, are reserved.
No Warranty. Company makes no warranty with respect to the Company Confidential Information, which is provided “as is” and with all faults. Therapist acknowledges and agrees that Company does not have control over Therapist’s provision of Therapy Services or use of Company Confidential Information, and Company does not warrant the results that may be obtained through the Therapy Services or through use of Company Confidential Information. Without limiting the generality of the foregoing, Therapist acknowledges and agrees that it is solely responsible for evaluating and treating Therapist’s patients and that Company will have no involvement or responsibility with respect to Therapist’s delivery of Therapy Services. Therapist assumes all risks and responsibility for its provision of Therapy Services and use of Company Confidential Information. To the fullest extent permitted by law, Company makes and Therapist receives no representations or warranties of any kind, whether express, implied, statutory or allegedly extended in any communication with Therapist. The Company Confidential Information is intended to be used by trained professionals only and is not a substitute for professional judgment. Therapist acknowledges and agrees that Company cannot anticipate every medical circumstance or condition of an individual patient, and Therapist agrees that it shall notify each patient to that effect.
Limitation of Liability. To the maximum extent permitted by applicable law, in no event will Company be liable for any damages, including lost profits, incidental, consequential, indirect or punitive damages arising out of or relating to this Agreement, the Therapy Services or use of the Company Confidential Information, however caused, and on any theory of liability, whether in contract, tort, indemnity or otherwise. This limitation will apply even if Company has been advised of the possibility of such damage.
Indemnification. Therapist agrees to indemnify, defend and hold harmless the Company from and against all claims, demands, losses, costs, expenses, obligations, liabilities, damages, recoveries, and deficiencies, including without limitation interest, penalties, attorneys’ fees and costs, that the Company may incur or suffer as a result of or related to any intentional acts, omissions, negligence, wilful misconduct and any breach or alleged breach or failure to perform any of the representations, warranties or obligations in this Agreement, including without limitation any allegations related to the Therapy Services provided or Company Confidential Information used by Therapist.
Term. This Agreement shall begin on the Effective Date and shall continue in effect for a period of exactly six (6) months unless terminated by either Party pursuant to Section 10(b) (the “Term”).
Termination. Notwithstanding the foregoing, this Agreement may be terminated: (i) by mutual written agreement of the Parties; (ii) by either Party, at any time, by providing the other Party with written notice of termination, which termination shall become effective thirty (30) days after the date of such notice; (iii) by either Party if the other Party breaches this Agreement and fails to cure such breach within five (5) days after the date of notice specifying such breach; (iv) automatically if there is instituted by or against the other Party proceedings in bankruptcy or under insolvency Laws or receivership or dissolution, or if the other Party makes an assignment for the benefit of creditors or admits insolvency or becomes insolvent, in which case termination shall be effective upon such Party’s receipt of the termination notice; (v) automatically upon Therapist’s loss of Certification through expiration or revocation, violation of any Law (including any breach under Section 14 hereto) or breach of the license restrictions set forth in Section 5, in which case termination shall be effective immediately (in each case, the effective date of termination shall be referred to herein as the “Termination Date”). Upon any termination of this Agreement, the licenses granted in Section 2 shall automatically and immediately terminate.
Survival. Upon any termination of this Agreement, Sections 2(c) and 2(e), along with Sections 5 through 11 and Section 14 shall survive and remain in full force and effect. Without limiting the generality of the foregoing, upon any termination of this Agreement, Therapist may not disclose any of Company’s Confidential Information, or create, disclose or use any derivative works or modified form of the Company Confidential Information.
Injunctive Relief for Breach of Agreement. Therapist acknowledges and agrees that Therapist’s failure to perform any of Therapist’s covenants in Sections 5, 6, 7, 9 and 14 would cause irreparable injury to Company and cause damages to Company that would be difficult or impossible to ascertain or quantify. Accordingly, without limiting any remedies that may be available with respect to any breach of this Agreement, Therapist consents to the entry of an injunction to restrain any breach of Sections 5, 6, 7, 9 and 14 without any necessity to post any bond or provide any security in connection therewith.
Dispute Resolution. If a dispute arises from or relates to this Agreement or the breach thereof, and if the dispute cannot be settled through direct discussions, the Parties agree to endeavor first to settle the dispute by mediation administered by the American Arbitration Association under its Commercial Mediation Procedures before resorting to arbitration, which mediation shall be scheduled within 30 days of any request to mediate by either Party. If the Parties do not resolve the dispute within 45 days of any such request to mediate, any dispute arising from or relating to this Agreement or breach thereof shall be settled by arbitration administered by the American Arbitration Association in accordance with its Commercial Arbitration Rules, and judgment on the award rendered by the arbitrator may be entered in any court having jurisdiction thereof. The place of any mediation or arbitration shall be Salt Lake City, Utah. If the Parties do not agree to an arbitrator within 10 days following the initiation of arbitration by either Party, each Party shall submit the name of an arbitrator affiliated with the American Arbitration Association offices in Salt Lake City, Utah, and the two named arbitrators shall appoint another arbitrator who shall solely preside over the arbitration proceeding. Either Party may apply to the arbitrator seeking injunctive relief until the arbitration award is rendered or the controversy is otherwise resolved. Either Party also may, without waiving any remedy under this Agreement, seek from any court in Salt Lake City, Utah having jurisdiction, any interim or provisional relief that is necessary to protect the rights or property of that Party, pending the establishment of the arbitral tribunal (or pending the arbitral tribunal’s determination of the merits of the controversy). Consistent with the expedited nature of arbitration, each Party will, upon the written request of the other Party, promptly provide the other with copies of documents relevant to the issues raised by any claim or counterclaim. Any dispute regarding discovery, or the relevance or scope thereof, shall be determined by the arbitrator, which determination shall be conclusive. All discovery shall be completed within 60 days following the appointment of the arbitrator. At the request of a Party, the arbitrator shall have the discretion to order examination by deposition of witnesses to the extent the arbitrator deems such additional discovery relevant and appropriate. Depositions shall be limited to a maximum of three per Party and shall be held within 30 days of the making of a request. Additional depositions may be scheduled only with the permission of the arbitrator, and for good cause shown. Each deposition shall be limited to a maximum of six hours duration. All objections are reserved for the arbitration hearing except for objections based on privilege and proprietary or confidential information. The prevailing Party shall be entitled to an award of reasonable costs and fees, which shall include, without limitation, all reasonable pre-award expenses of the arbitration, including the arbitrators’ fees, administrative fees, travel expenses, out-of-pocket expenses such as transcription, reporting, copying and telephone, court costs, expert and percipient witness fees, and attorneys’ fees.
Therapist shall inform Company promptly in writing of any alleged infringement of the Company Confidential Information by a third party that Therapist becomes aware of and of any available evidence thereof.
During the Term, Therapist shall have the right, but shall not be obligated, to prosecute at its own expense all infringements of the Intellectual Property if Therapist provides Company advance written notice of its intent to prosecute; provided, however, that such right to bring such an infringement action shall remain in effect only for so long as the License granted herein remains exclusive. Company hereby agrees that Therapist may include Company as a party plaintiff in any such suit, without expense to Company. Therapist shall indemnify Company against any order for costs that may be made against Company in such proceedings.
In any case, Company shall have the right, but shall not be obligated, to prosecute at its own expense any infringement of the Company Confidential Information, and Company may, for such purposes, use the name of Therapist as party plaintiff. Company shall bear all costs and expenses of any such suit.
In the event that a declaratory judgment action alleging invalidity or infringement of any part or all of the Company Confidential Information shall be brought against Company, Therapist, at its option, shall have the right, within ninety (90) days after commencement of such action, to intervene and take over the sole defense of the action at its own expense.
In any infringement suit filed by Company to protect any of the Company Confidential Information, Therapist shall, at Company’s request and expense, cooperate in all respects and, to the extent possible, have its employees testify when requested and make available relevant records, papers, information, samples, specimens, and the like.
The “Act” shall mean the Health Information Technology for Economic and Clinical Health Act.
“Breach” as referenced in Section 13400(1)(A) of the Act.
“Business Associate” shall generally have the same meaning as the term “Business Associate” at 45 CFR 160.103, and in reference to the party to this Agreement, shall mean Therapist.
“Covered Entity” shall generally have the same meaning as the term “Covered Entity” at 45 CFR 160.103, and in reference to the party to this Agreement, shall mean the Company.
“Designated Record Set” as referenced in 45 CFR §164.501.
“Disclosure” as referenced in 45 CFR §160.103.
“Minimum Necessary” as referenced in 45 CFR 164.502(b).
“Person” as referenced in 45 CFR §160.103.
“Protected Health Information” as referenced in 45 CFR §160.103.
“Required By Law” as referenced in 45 CFR §164.103.
“Secretary” shall mean the Secretary of the Federal Department of Health and Human Services or his/her designee.
“Security Incident” as referenced in 45 CFR §164.304.
“Subcontractor” as referenced in 45 CFR 160.103.
“Unsecured Protected Health Information” as referenced in §13402(h) of the Act.
“Use” as referenced in 45 CFR §160.103.
Business Associate may only Use or Disclose Protected Health Information as necessary to perform the services set forth in this Agreement and only as Required By Law.
Business Associate may not Use or Disclose Protected Health Information in a manner that would violate Subpart E of 45 CFR Part 164 if done by Covered Entity except for the specific Uses and Disclosures set forth below.
Business Associate may Use Protected Health Information for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate.
Business Associate may only Disclose Protected Health Information for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate, provided the Disclosures are Required By Law, or Business Associate obtains reasonable assurances from the Person to whom the information is disclosed that the information will remain confidential and Used or further Disclosed only as Required By Law or for the purposes for which it was Disclosed to the Person, and the Person notifies Business Associate of any instances of which it is aware in which the confidentiality of the information has been Breached.
As to all Protected Health Information, when it is no longer needed by Business Associate for its proper management and administration or to carry out its legal responsibilities, then at Covered Entity’s sole discretion: (i) return to Covered Entity such Protected Health Information or (ii) destroy all such Protected Health Information retained.
Notices. All notices, requests, demands, claims and other communications hereunder (collectively, “Notices“) must be in writing. Any Notice will be duly given if (and be deemed received two (2) business days after) it is sent by registered or certified mail, return receipt requested, postage prepaid, and addressed to the Parties as provided in this Agreement.
Relationship of the Parties. Therapist is solely responsible for the manner and hours in which Therapy Services are performed. Therapist is solely responsible for all taxes, withholdings and other statutory, regulatory or contractual obligations of any sort (including, without limitation, those relating to workers’ compensation, disability insurance, Social Security, unemployment compensation coverage, the Fair Labor Standards Act, income taxes and compliance with other Laws), and is not entitled to participate in any employee benefit plans, fringe benefit programs, group insurance arrangements or similar programs of Company. Nothing contained in this Agreement shall in any way be construed to create an agency relationship, partnership, employment relationship or joint venture between the Parties. Company does not warrant or guarantee in any way the successful acquisition of clientele to Therapist, and Company reserves the right to solicit to those clients within the databases and information held by the Company regardless of the current relationship the client has with Therapist. Without written permission, no more than 50% of business conducted by Therapist shall include using Therapy Modality methodologies. Notwithstanding the relationships of the parties governed by this agreement, separate agreements may be entered into to create an agency relationship, partnership, employment relationship or joint venture between the Parties.
Choice of Law. This Agreement, its application and interpretation, and all rights and obligations of the Parties hereunder shall be governed by and construed exclusively in accordance with the laws of the State of Utah, excluding any choice of law rules which would apply the laws of another jurisdiction.
Assignment; Binding Effect. Therapist may not assign this Agreement without Company’s prior written consent, which may be withheld in Company’s absolute discretion. This Agreement shall be freely assignable by Company. This Agreement shall binding upon and inure to the benefit of any permitted successor or assign of each Party.
Entire Agreement. This Agreement represents the entire understanding between the Parties hereto with respect to the subject matter hereof, and this Agreement supersedes all previous representations, understandings or agreements, oral or written, between the Parties with respect to the subject matter hereof.
Severability. Should one or more of the provisions of this Agreement become void or unenforceable as a matter of law, then this Agreement shall be construed as if such provision were not contained herein, and the remainder of this Agreement shall be in full force and effect.
No Waiver. No waiver of any breach of any covenant or condition herein shall constitute a waiver of any subsequent breach.
Amendment. No change or modification to this Agreement shall be valid unless the same shall be in writing and signed by the Parties hereto.
Independent Counsel. Therapist acknowledges that this Agreement has been prepared on behalf of the Company, by the Company’s counsel. The Company’s counsel does not represent, and is not acting on behalf of, Therapist. Therapist has been provided with an opportunity to consult with Therapist’s own counsel with respect to this Agreement.
Counterparts. This Agreement may be executed via facsimile in one or more counterparts and transmitted via facsimile or .pdf, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. When counterparts of copies have been executed by all Parties, they shall have the same effect as if the signatures to each counterpart or copy were upon the same document and copies of such documents shall be deemed valid as originals.
IN WITNESS WHEREOF, The Parties hereto have executed this Agreement as of the date of acceptance by Therapist.

References: §164
 §160
 §160
 §160
 §164
 §164
 §13402
 §160