The Resource Specialist program offers case management and community resource services to children, youth, and their families.  Resource Specialists assist clients in connecting to services and resources and, whenever possible, finding support within the community. 

Child/Youth Information

Parent/Guardian Information

Some resources require the parent's date of birth and health insurance information.  Providing this information is optional and can be provided in this form or directly a JJAB employee. 

Additional Parent/Guardian Information (if applicable)

As a client of the Los Alamos JJAB you have the following rights and responsibilities.

Rights:

1. You have the right to services and cannot be discriminated against based on race, religion, creed, color, national origin, gender, pregnancy, sexual orientation, gender identity, age, ancestry, physical or mental disability, genetic information, marital status or any other classification protected by local, state or federal law.
2. You have the right to receive the JJAB Privacy Policy, to know that JJAB services are confidential, and to sign a Consent for Services.
3. You have the right to:
   1. Request information relating to services offered by JJAB and the availability of other services offered in Los Alamos and surrounding counties. 
   2. Receive an explanation of how each program works with you and your family to access services through referrals, JJAB Programs, groups, and community services.
   3. Be notified by JJAB if an accident, injury, or illness occurs to your child/teen during the time of an interaction with a JJAB employee, of which the employee has knowledge.
4. You have the right to a humane and safe environment, free from exploitation or harm.
5. You have the right to give consent for treatment/services, and to end treatment/services at any time.
6. You have the right to know the expected length of services, reason for termination of services and/or the reason for referral to another provider or agency.
7. You have the right to request your records in accordance with JJAB policy and acceptable mental health practices.

 If participating in the JJAB Therapeutic Program:

• You have the right to be treated with compassion, dignity, and respect in accordance with professional ethical standards governing counselors and art therapists.Build
• You have the right to be informed about alternative therapy options that may be helpful.
• You have the right to understand your diagnosis and express your goals for treatment.
• You have the right to participate in creating and evaluating your treatment plan.

 

Responsibilities:

1. It is your responsibility to complete and update all JJAB paperwork.
2. It is your responsibility to communicate any changes in your or your child/teen’s situation that may impact current services or the nature of the services needed.
3. If you wish participation of a JJAB employee at any school‐related meetings for your child/teen, it is your responsibility to request the employee’s support and assistance.
4. It is your responsibility to request a change to services, including but not limited to type of services, a change in service provider, and/or change of JJAB employee.
5. You will need to understand that other community‐based services that JJAB refers you/your child to may not be free of charge and that you are responsible for any payment for those services.
6. It is your responsibility to be familiar with the service limitations of the program you or your child participate in.

 
JJAB services do not include the following:

• Urgent and emergency services; medical consultation; emergency care or transport to emergency services; if there are urgent/emergent needs, call 911.
• Legal services.
• Transport to/from any site.

 

This notice describes how personal/private information (PPI) about you may be used and disclosed and how you can get access to this information. Please review it carefully.

JJAB will abide by New Mexico state laws as well as federal HIPAA policies. This Notice of Privacy Practices describes how your protected health information may be used and disclosed to carry out operations within our programs and/or therapy treatment for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.

Your Rights
When it comes to your personal information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your information

• You can ask to see or get a copy of your Case Management or Therapeutic file and other personal information we have about you.
• We will provide a copy or a summary of your personal information, usually within 30 days of your written request.

Ask us to correct your information

• You can ask us to correct personal information about you that you think is incorrect or incomplete.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone). We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

• All information will remain confidential except in the following circumstances: danger of one acting on suicidal or homicidal thoughts, suspected child or vulnerable adult abuse or neglect, or court order or valid subpoena.
• You can ask us not to use or share certain personal information for our referral services, therapeutic program, or our operations.
• JJAB is required to share aggregate information with organizations, grantors, and contractors that provide funding for our programs. 

Choose someone to act for you

• If you have given someone power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your service referral.
• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• If you feel your rights have been violated, you can make a complaint by contacting us directly at (505) 709-8125 or info@losalamosjjab.com.
• You may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/.
• We will not retaliate against you for filing a complaint.

Your Choices
You have a right and a choice regarding the sharing of any of your information.  For certain information, you can tell us your choices about what we may share. If you have a clear preference for how we share your information in the situations described below, talk to us.

Sharing Information

• For JJAB to share any information with any person or organization, except in the circumstances defined above, you must sign a Consent of Services and/or a Release of Information. 
• A Release of Information is a document signed by you, where you explicitly state with whom we can share case related information about you.  This may allow us to share information with your family, close friends, your school, or others involved in your care.

Our Uses and Disclosures
How do we typically use or share your personal information?

Referral Services

We can use your personal information and share it with other professionals for referral purposes. Example: A Resource Specialist may refer you to a medical provider if you identify a need for services.

Run our organization

We can use and share your personal information to improve your care and contact you when necessary.

• The organization is the owner of all official JJAB documents which are kept confidential as directed by privacy rules.

Obtain funding for the programs used to aid and support you

With your permission, JJAB may share your information with Los Alamos County, the administrative grant unit of the New Mexico Children, Youth, and Families Department (CYFD), and/or other government agencies to provide funding to our programs.

• This information can include the youth’s full name, full address, date of birth, gender, ethnicity, race, and tribal affiliation. 

JJAB shares de-identified information with other organizations/grantors that provide funding for our programs.

• This can include aggregate information by age, gender, ethnicity, race, tribal affiliation and/or zip code/city of residence.
• We may release your health information to funding and government agencies authorized to conduct audits, investigations, and inspections of our facilities and services.

Safety issues

We can share personal information about you under certain situations such as:

• Reporting suspected abuse or neglect.
• Preventing or reducing a serious threat to health or safety.
• To a family member, relative, or close personal friend who is involved in your treatment. We may also disclose your health information to help notify or locate a family member or other person responsible for your care.

Do research or for program development

We can use or share de-identified information for program development. Example: JJAB may report compiled data such as - 24 Youth expressed a need for walk-in mental health services. 

Comply with the law

We will share information about you if state or federal laws require this.  It may include, but not be limited to:

• Sharing information with the Department of Health and Human Services in order for the agency to verify that we are compliant with federal privacy law.
• For law enforcement purposes or with a law enforcement official.
• With oversight agencies for activities authorized by law.

Respond to lawsuits and legal actions

We can share information about you in response to a court order or valid subpoena.

 

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected personal information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of the Privacy Policy. We will not use or share your information other than as described here unless we inform you in writing. If you give us permission to share your information, this permission may be revoked at any time.  This revocation must be put in writing and provided to JJAB. 

 The Effective date on this Notice or Privacy Practices is 10/01/2025. We may change our privacy practices from time to time. We may make the changed notice effective for health information we already have. If we change the notice, we will provide you with the revised notice.

 

The Resource Specialist program offers case management and community resource services to children, youth, and their families.  Resource Specialists assist clients in connecting to services and resources and, whenever possible, finding support within the community. 

For JJAB to provide effective services, I consent to services for my child(ren) and myself and authorize the mutual exchange of information with the JJAB Resource Specialist for the purposes of providing services, groups, and referrals for resources.  

To promote an effective working relationship, the JJAB Resource Specialist may conduct intake and exit meetings and request participation in client assessments and/or program feedback surveys.  As with all services, client/caregiver participation in assessments or surveys is voluntary.

My child may be receiving other JJAB services while they are simultaneously receiving Resource Specialist services. I understand that information will be shared between my child's Resource Specialist and other JJAB staff for the purposes of coordination and optimal service delivery.

We have discussed how we will handle casual encounters.

I have received a copy of the JJAB Privacy Policy.

Unless authorized, except for the following circumstances, all information will remain confidential per the JJAB Privacy Policy: danger of one acting on suicidal or homicidal thoughts, danger of injury to oneself or others, suspected child or vulnerable-adult abuse or neglect, or court subpoena. This authorization may be revoked at any time by submitting a written request to JJAB Program Manager (P.O. Box 4716, Los Alamos, NM  87547 or info@losalamosjjab.com).

I hereby certify that this request for services has been made voluntarily. I have read this entire Consent for Service, and I understand and agree to these arrangements and request the services of the Resource Specialist Program.  Electronically signing this document indicates that you have understood your rights and responsibilities and have given consent to begin services.

All information will remain confidential according to the JJAB Privacy Policy unless I have authorized its exchange below, except in the following circumstances: danger of harm to self or others, suspected child or vulnerable-adult abuse or neglect, or court order or valid subpoena.

Parent Release of Information:  For the purpose of providing coordination of client resources and services, I as the legal guardian and/or custodial parent of above-named child, authorize Los Alamos JJAB to release and obtain information between the Los Alamos JJAB employees and the following person(s):

Client Release of Information (if age 18):  For the purpose of coordination of client resources and services, I authorize Los Alamos JJAB to release and to obtain information between Los Alamos JJAB employees and the following person(s):

 

(Please be as specific as possible below in providing names of organizations or individuals that information may be released to)

Information being requested may be released verbally and in writing.

This authorization will expire at the time my case is closed unless I have specified, in writing, another date or event that will trigger expiration. This authorization may be revoked at any time by submitting a written request to Los Alamos JJAB at P.O. Box 4716, White Rock, NM  87547 or at info@losalamosjjab.com.

I hereby certify that this request has been made voluntarily. 

Thank you for completing the paperwork.  Clicking on "submit" will provide the information to the JJAB.