Liability Release for Remote Administration of the Safe and Sound Protocol

 

Kimberly Muzzi-Gunn

Serenity-now.ca

 

Release and disclosure: The Safe and Sound (SSP) is a member of the new class of auditory treatment techniques and protocols referred to as an Auditory-Based Therapy. While still considered experimental, these techniques are being used by Therapist, Educators, Physicians, Psychologists and laypeople worldwide. The SSP was developed in a scientific lab for the purposes of treating the social engagement issues related to autism and hyperacusis; all based on Dr. Stephen Porges' Polyvagal Theory. Since its release to the public in April 2017, these and other disciplines are finding value in it, adding it to their treatment regimens. Any use of this protocol outside the scope of autism is largely unstudied. There are many case studies of a variety of diagnoses showing positive change, yet typical outcomes for other conditions have not yet been established.

To date, the SSP has yielded exceptional results in the treatment of social engagement/emotional regulation problems and auditory processing abilities. No one teaching or practicing SSP can know with certainty whether it will help a specific individual or address a specific problem. SSP is not meant to replace appropriate medical treatment and therapies or mental health counseling.

Clinical diagnosis are not required to seek treatment, however, if trauma history of any kind is present, it must be fully disclosed prior to treatment. The SSP is a powerful intervention that can potentially aid therapeutic work to alleviate many of the lingering adverse effects of trauma, but close supervision by a trained mental health professional during and following treatment needs to be adhered to.

I attest that myself/or my child have not:

  • Engaged in self-injury behaviors

  • Experience(d) suicidal thoughts

  • Have not recently started or changed type/dosage of a psychiatric medication

  • Recently suffered a head injury or experienced significant medical instability

  • Is currently experiencing seizures

  • Has a history of significant trauma

  • Live in an unstable/difficult household

  • Experienced a recent major destabilizing personal life event (divorce, death, job loss, etc.)

I have read the following contract carefully and understand that this protocol will be administered to my child and/or me in the best, appropriate manner. I release all liability for any adverse outcomes, either temporary or long-term, associated with the use of this program.

Client/Parent:

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