Information and Consent to Participate

Information and Consent to Participate

Measurement Based Care and

Utilization of Greenspace Mental Health

INTRODUCTION

Sunnybrook Health Sciences Centre (“SHSC” or “Sunnybrook”) Department of Psychiatry is introducing an evidence-based approach in its assessment and management of psychiatric symptoms. This approach is called Measurement Based Care (“MBC”).

MBC is being offered by SHSC using a digital health management service located at https://sunnybrook.portal.gs/ (the “Portal”), hosted on the internet by SHSC’s electronic service provider, Greenspace Mental Health Ltd. (“Greenspace”).

Sunnybrook’s use of MBC to assess and manage your care and use of the Portal in your care are each voluntary and require your consent as described in this information and consent form (the “SHSC Consent”). At this time, if you wish to consent to Sunnybrook’s use of MBC, but not use of the Portal, you may do so by contacting your SHSC health care provider. If you do not consent to use of the Portal, do not agree to these terms. If you wish to consent to use of MBC and use of the Portal, you may do so by completing the consent process described in this form. In the future, Sunnybrook may transition to offering MBC exclusively using the Portal, at which time you will be required to provide your consent to using the Portal in order to continue being treated with MBC.

1 - SHSC Consent

If you complete this consent form, you are consenting to Sunnybrook’s use of MBC for your care and you are also consenting to use of the Portal to manage your information for MBC purposes. If you do not consent to MBC and use of the Portal for assessment and management of your care, then you must not agree to this consent form.

2 - Greenspace Patient Use Consent

If you consent to the use of MBC through the Portal, your use of the Portal is also governed by terms of use and privacy policies between yourself and Greenspace, available on the Portal (the “Greenspace Terms”).

You must separately agree to and comply with the Greenspace Terms in order to access and/or use the Portal.

If you consent to the use of the Portal, personal health information that you input on the Portal will be stored and made available to SHSC by Greenspace for the purpose of your care and other uses described in this information and consent form. Your information may also be collected, used or disclosed by Greenspace, pursuant to your agreement directly with Greenspace.

If you do not want Sunnybrook to use Greenspace for assessment and management of your care OR you do not agree with the terms of this SHSC Consent OR do not intend to agree to and comply with the Greenspace Terms in order to access and/or use the Portal, then you must not agree to this consent form.

CONSENT FORM

This SHSC Consent authorizes SHSC to collect personal health information about you for MBC purposes and the other purposes described herein using the Portal. The Greenspace Terms impose further requirements on your use of the Portal and authorize Greenspace to collect, use and disclose your information as detailed in the Greenspace Terms. Please note: the Greenspace Terms create a direct relationship between you and Greenspace, and SHSC has no control over your agreement with Greenspace. If you do not agree with this SHSC Consent or the Greenspace Terms, you must not use the Portal.

Your participation in MBC and your use of the Portal is entirely voluntary and requires your consent (opt-in). Once you start participating, you can stop at any time. In order to terminate your account with Greenspace, you must notify Greenspace in accordance with the Greenspace Terms.

If you wish to participate in MBC and the Portal, please read and confirm your agreement by clicking to indicate your consent at the bottom of this window, for both the SHSC Consent and the Greenspace Terms. It is important that you read and understand the contents of this SHSC Consent and the Greenspace Terms before you confirm your agreement.

WHAT WILL HAPPEN PRIOR TO MY ASSESSMENT?

Once registered for an account, you will be asked to complete specific symptom questionnaires through the Portal. The questionnaires have been chosen specifically by your clinicians after taking into consideration your unique mental health concerns. The questionnaires are validated instruments designed to track key components of your mental wellbeing: your mood, sleep, energy, appetite, feelings, thoughts and functioning.

Each questionnaire takes about 2-5 minutes to complete. Throughout your treatment time at the Department of Psychiatry, you will be asked to repeat these questionnaires. Your clinician will then be utilizing that information to guide their clinical decision making around your treatment.

Certain names, graphics, logos, icons, designs, words, titles and phrases on the Portal constitute trade-marks, trade names, trade dress and associated products and services of Sunnybrook or Greenspace, and are protected in Canada and internationally and their display on the Portal does not convey or create any licence or other rights in these trade-marks, trade names, trade dress and associated products and services. Any use of any of same, in whole or in part, without prior written authorization of Sunnybrook or Greenspace, as applicable, is strictly prohibited. Please note that the Greenspace Terms include similar and additional terms relating to content on the Portal.

HOW WILL YOU STORE MY INFORMATION IF I CONSENT?

SHSC has procured the services of Greenspace as a digital health platform. Your information will be collected through the Portal and stored by Greenspace on behalf of Sunnybrook. Patients who wish to use the Portal are required to consent to the Greenspace privacy policies (which form part of the Greenspace Terms). Greenspace has agreed that personal data will not be used by Greenspace for the purposes of product development, marketing, or the provision of deliverables to other customers of Greenspace.

HOW WILL SHSC USE MY INFORMATION?

SHSC will have access to the responses you provide in the Portal. Your personal health information will be used by SHSC for the following purposes:

• to track your symptoms in order to provide treatment tailored to you and increase education about mental health; and
• to aggregate, on an anonymous basis, with data from other patients, to support quality improvement by SHSC.

In the course of providing services to SHSC, including the Portal, Greenspace may require limited access to your personal health information.

The Portal is not a means of communication with your physician directly. You are solely responsible for notifying your doctor of any changes in your mood that you feel needs immediate attention or treatment. The Portal is not for reporting or treating emergencies. If you have a medical or mental health emergency, call 911 or go to the nearest open clinic or emergency room immediately. The Portal is not medical advice or a substitute for medical treatment, advice or diagnosis, and under no circumstances should you attempt self-treatment based on anything you see or read on the Portal.

Sunnybrook reserves the right at any time, and from time to time, to suspend or terminate its use of the Portal (or any part or function thereof).

WHAT ARE THE BENEFITS OF MEASURING MY SYMPTOMS AND FUNCTIONING?

The benefits include potential faster response to treatment and quicker recovery times, in addition to increased access to education about your mental health. Aggregated anonymous data will also be used to improve mental health service delivery, inform program development, and direct quality improvement initiatives.

WHAT ARE THE RISKS AND HARMS?

There are no medical risks to you but tracking symptoms may sometimes make you feel uncomfortable. You may refuse to answer questions or stop participating at any time.

In addition, while all personal health information will be handled with the utmost confidentiality and care, Sunnybrook does not warrant or guarantee the confidentiality or security of the Greenspace platform. By using the Portal and accepting the Greenspace Terms, you acknowledge and accept the inherent risks of using an electronic, internet-based digital health management service.

WHAT IF I WANT TO STOP TRACKING MY SYMPTOMS?

Taking part in measuring your symptoms is voluntary. Deciding not to take part or deciding to discontinue use of MBC and/or the Portal will not result in any penalty or affect your health care plan and relationship with your health care provider(s) at SHSC.

ARE THERE ANY COSTS INVOLVED?

There is no cost to you.

WHAT IF I HAVE ANY ADDITIONAL QUESTIONS?

If you have further specific questions about the questionnaires or measurement based care, we recommend you discuss with your clinician further.

Any questions about this SHSC Consent may be directed to your SHSC health care provider. Any questions about the Greenspace Terms may be directed to: support@greenspacehealth.com.

CONSENT

I have read, understand and agree to this SHSC Consent.

I understand that MBC involves the collection of my personal health information.

I agree to the use of MBC and the Portal in my care, and that SHSC may collect, use, disclose and retain my personal health information for the purposes described in this SHSC Consent and other purposes that are permitted by applicable law.

I understand that some of the information collected through the Portal will be part of my medical record.

I understand that my responses will not be monitored constantly by SHSC, and I understand the Portal is not an emergency service and does not substitute medical treatment, advice or diagnosis in the case of an emergency. I agree that I should call 911 and/or seek urgent medical assistance in the event of an emergency.

I understand that SHSC is using an electronic service provider, Greenspace, and that my use of the Portal is governed by the Greenspace Terms, and that I must agree to the Greenspace Terms in order to use the Portal.

I agree to access and use the Portal for MBC and the other purposes described in this SHSC Consent. I agree to being contacted by email and electronically through the Portal.

By clicking the box below, I confirm that I have read and understood, and agree to, the contents of the SHSC Consent. I agree to (A) the use of MBC in my care and (B) the use of the Portal and my personal health information as described in the SHSC Consent.