Fifth Street Counseling Center IV

SERVING BROWARD COUNTY SINCE 1991

4121 NW 5th Street, Suite 206, Plantation, FL 33317-2158

901 South State Road 7, Suite 240, Hollywood FL 33023

PH: 954.797.5222 FX: 954.797.7677

The goals and objectives of each psycho-educational program is to provide a supportive atmosphere to enable clients to learn more about themselves, as well as to establish and meet personal goals. Each group consists of lectures, group discussions, audio and/or video components.

13 or 16 Week Program

All clients enrolled in these programs are expected to complete 13/16 consecutive sessions. Two (2) absences, (cancelled or no-show) are allowed during the 13/26 weeks. Client will be terminated from the program after a third absence.

26 or 32 Week Program

All clients enrolled in these programs are expected to complete 26/32 consecutive sessions. Four (4) absences, (cancelled or no-show) are allowed during the 26/32 weeks. A client will be terminated from the program after a fifth absence or after three consecutive absences (cancelled or no-show

52 Week Program

All clients enrolled in these programs are expected to complete 52 consecutive sessions. Eight (8) absences, (cancelled or no-show) are allowed during the 52 weeks. Client will be terminated from the program after a ninth absence or after three consecutive absences (cancelled or no-show

Each absence requires a make-up session, which must be completed in the same group that the participant attends each week. Three consecutive absences (cancelled or no-show) will be grounds for termination.

1. All fees are based on a sliding scale, which is determined by household income.

2. In order to gain credit for a session, all group fees must be paid for at the time of session. Clients will not receive credit for a service unless fees are paid in advance, or at the time of the service. A client should contact the office manager to discuss any fee arrangements.

3. If a client does not cancel at least 24 hours prior to his/her group time, he/she will be charged for the group. Clients can cancel a group via phone or in-person.

4. Clients will be charged a $10 change fee each time you to reschedule your group day, group time or location, for any reason.

5. Clients are subject to a monthly fee for a Treatment Plan Review usually equal to the weekly group fee.

6. No cash payments, please. We accept debit/credit cards, money orders or personal checks, with proper matching government-issued valid photo identification.

1. Clients can expect to be treated with respect by all personnel at Fifth Street at all times.

2. Clients can expect to be assigned a primary therapist during this Orientation session.

3. Clients can expect to be recommended to the least restrictive treatment, taking into consideration any court orders or special conditions.

4. Clients can be assured of confidentiality in regards to disclosure of information in accordance with Florida law.

5. Right To Individual Dignity: The individual dignity of the client will be respected at all times and under all circumstances.

6. Right to Non-discriminatory Services: Clients will not be denied access to services solely based on race, gender, ethnicity, age, sexual orientation, sexual identity, human immunodeficiency virus status, prior service departures against medical advice, disability, number of relapse episodes, or prescribed medications.

7. Rights to Quality Services: Clients will be provided with services suited to his/her individual needs, administered skillfully by licensed or certified professionals, safely, humanely, with full respect for his/her dignity and personal integrity, and in accordance with all statutory and regulatory requirements.

8. Clients will be provided with a copy of Fifth Street Counseling Center telephone number, 954-797-5222.

9.Clients will be provided with a copy of the listed telephone numbers: to report incidents of abuse, neglect or exploitation to the State Abuse Registry call 1-800-96-ABUSE or to the Drug/Alcohol and Mental Health Program Office 954-762-3700 and Florida Advocacy Council 954-713-3071.

1. Clients can be assured of confidentiality in regards to disclosure of information in accordance with Florida Law, which states that reports of intent to harm self, harm to others, abuse of a child or an elderly person mandates reporting to the appropriate authorities.

2. Clients may not repeat anything that another client may disclose during a group session.

3. Parents or legal guardians have access to information and participation in treatment planning for children under the age of 18.

4. Drug or alcohol screenings, which prove positive, will be reported to the referring parties. 5.Information about your participation in any services at Fifth Street Counseling Center IV, Inc. is limited to only those individuals or organizations that you specify on your Consent to Release Information form.

1. A urine sample or a breath sample may be requested at any time by a counselor.

2. Clients enrolled in drug/alcohol programs are not allowed to use illicit substances or alcohol.

3. If a client refuses to provide a urine or breath sample, it may be treated the same way as if the test was taken and it proved positive for drugs or alcohol.

If a urine test proves positive for illicit substances, a prescription medication without a valid prescription or alcohol use, the client will be subject to a reevaluation at their expense. A reevaluation may result in a revised recommendation.

There is a $45.00 charge for all drug screen urinalysis and alcohol breath testing.

If you have active prescription medications, you are required to provide a copy of your active prescriptions each 30 days. Testing positive for a prescription medication, which is not on file, may be reported to the referring parties. Prescription medications are subject to pill counts, upon request.

Hand Washing The spread of many pathogens can be prevented with regular hand washing. You should thoroughly wash and dry your hands after using the restroom.

It is widely known that intact and healthy skin is a major barrier to pathogens. Any cuts or abrasions should be covered with a waterproof dressing.

This agency is required to report all communicable diseases to the Florida Department of Health in accordance with Florida Statute 381.0031 and 384.25.

The purpose of this procedure is to provide a client with an opportunity for an administrative settlement of a legitimate grievance.

1. Agrievance is defined as a formal complaint by a client concerning an incident, policy or condition at this agency, which affects a client personally.

2. Clients can grieve the following matters; the substance, interpretation and application of policies and the rules and procedures that affect them.

3. Clients cannot grieve State and Federal Court decisions, State and Federal laws and regulations, Parole Board decisions, or other matters that are beyond the control of this agency.

Clients can also put their grievances in writing and direct this writing to the Director of the Program.

If you have a grievance first discuss the issue with your primary therapist or a staff manager. If the issue is not resolved,the client can ask to speak with the Clinical Director, by phone or in-person, within 24-48 hours of the incident.

If the Clinical Director cannot resolve the issue, a written description of the issue can be addressed to the Chief Operating Officer and a response will be issued within ten working days.

1.All clients are required to arrive for group 15 minutes prior to the appointment time, no exceptions. Clients that arrive after this time may not be allowed to receive services and may be charged.

2.All clients are encouraged to maintain their own records related to the services that they have attended.

Clients are not permitted to leave the group room during the session.

4. Clients are asked to not take or receive calls or texts during groups. In emergency situations, please request permission from your counselor to monitor your phone in advance of the session beginning. Otherwise, please turn off your phone or other devices during group sessions.

Clients may bring a beverage into group sessions, we ask that you discard your empty bottles as you exit. No eating is allowed during group sessions.

Payments for services can be made by money order, personal check (with matching valid government-issued photo ID), debit card or credit card. We cannot accept cash payments. Clients may pay-as-you-go or pay in advance. For those clients that choose to pay in advance, you are required to check-in prior to each group.

7. Aparticipant will not receive credit for a session under any one of the following conditions: (1) Amissed session (2) Failure to arrive on time (3) Non-payment for a service at the time the service is rendered (4) If a client arrives under the influence of alcohol or other drugs (5) If a client is disrespectful to a client or a staff member.

1. I am here to attend (check all applicable):

By signing this document, I acknowledge that I have attended a 90-minute Orientation Session during which I have been informed of the Policies and Procedures of Fifth Street Counseling Center IV, Inc. regarding: A description of the Services, Fees for Service, Infectious Control Procedure, Client Rights, Grievance Procedures and Random Drug Testing, and I agree to abide by these policies and procedures. I acknowledge that I have had the opportunity to ask the facilitator of this Orientation Session questions and that all of my inquiries have been completely satisfied. I understand that failure to comply with the program rules described in this Orientation Session may result in negative consequences such as Unsuccessful Discharge or a reevaluation.