INFORMED CONSENT AND PRIVACY POLICIES

THERAPY

The aim of therapy is to support individuals in their pursuit of greater autonomy and sense of safety in their own lives.

Therapy can help to repair family relationships; it can resolve interpersonal discourse, and it can aid in overall problem solving to set and attain life goals.

*There are to be no registered sex offenders on campus even if a parent or guardian of a client; telehealth sessions will be provided, if needed, to accommodate.

Benefits and Potential Harm to Therapy

Therapy also has potential risks. Approaching difficult feelings or thoughts can be painful and making changes in your beliefs or behaviors can be scary and sometimes disruptive to your current relationships. It is important that you consider carefully whether these risks are worth the benefits to you of changing. Most people who take these risks find that therapy is helpful.

Training and Approach to Therapy

Children’s Home Counseling Services (CHCS) staff are highly experienced and qualified in a variety of approaches and techniques. Our staff is handpicked and is made up of clinical supervisors and other known experts in their area of specialty.

For more information on specific specialties and approaches, you can visit our website under the “Who We Are” page.

Children’s Home Counseling uses a wide variety of techniques that may include dialogue, interpretation, cognitive reframing, awareness exercises, self-monitoring experiments, visualization, journal-keeping, experiential activities and assignments. If we propose a specific technique that may have special risks attached, we will inform you of that and discuss with you the risks and benefits of what we are suggesting. We may suggest that you consult with a physical health care provider or get involved in a support group or other therapy as part of our work together. For more detailed information on the specific training, education, and specialty of your counselor, visit our website under "Our Clinicians" to view your counselor’s biography.

Therapy with a Minor, Parent/Guardian Consent to the Following Policies

The involvement of children and adolescents in therapy can be highly beneficial to their overall development. Very often, it is best to see them with parents/guardians and other family members; sometimes they are best seen alone. We will assess which might be best for your child and make recommendations to you. The support of all the child’s caregivers is essential. The general goal of involving children in therapy is to foster their development at all levels. At times, it may seem that a specific goal is needed, such as to get the child to obey or reveal certain information. Although those objectives may be part of overall development, they may not be the best goals for therapy, which we will evaluate and discuss with you.

Legal/Custody

Because our role is that of the child’s helper, we avoid getting involved in legal disputes or other official proceedings unless compelled to do so by a court of law. Matters involving custody and mediation are to be handled by another professional who is specially trained in those areas rather than by the child’s counselor.

Please see our fee and payment schedule for costs, in the event we are ordered to participate in court proceedings, you are responsible for the fees associated 7 days PRIOR to the court date – these fees are NON-REFUNDABLE.

To provide services to minors we attempt to get approval from both parents/guardians or in the case of sole custody, a copy of the custody orders including parenting plan or any documentation related to decision-making or custody (guardianship, power of attorney, etc.). In the event we are unable to obtain parental consent from both parents we may or may not continue with therapy. This decision is at the discretion of the counselor and will be determined based on the child's best interest and legal/ethical parameters.

***Please note, we do not provide expert witness services for divorce, custody, or other legal disputes, unless directed to do so by a court order. In which case it must be known we are not certified custody evaluators.

Confidentiality

The issue of confidentiality is critical in treating children. Children under the age of 14, seen in individual sessions (except under certain conditions) are not legally entitled to confidentiality (also called privilege). However, unless children feel they have some privacy in speaking with a counselor, the benefits of therapy may be lost. Therefore, it is necessary to work out a balanced arrangement in which children feel that their privacy is generally being respected, and that parents/guardians have access to critical information. When parents/guardians or others join a child in session, what is discussed is known to those present and should be kept confidential and private.

The following circumstances override confidentiality:

• Confidentiality and privilege are limited in cases involving child abuse, neglect, molestation, or danger to self or others. In these cases, the counselor is required to make an official report to the appropriate agency and will attempt to involve parents as much as possible.
• 
  Minors may independently enter into therapy and claim the privilege of confidentiality in cases involving abuse or severe neglect, molestation, pregnancy, or communicable diseases, and when they are on active military duty, married, or officially emancipated. They may seek therapy independently for substance abuse, danger to self or others, or a mental disorder, but parents must be involved unless doing so would harm the child.
• 
  Any evaluation, treatment, or reports ordered by, or done for submission to a third party, such as a court or a school, is not entirely confidential and will be shared with that agency with your specific written permission.
  Please also note that we do not have control over information once it is released to a third party.

*Therapists will not release the health records of a child to a parent without expressed written consent of both parents.

The child should have privacy in his/her therapy sessions, and the parent/guardian will allow this privacy except in extreme situations, at which time the counselor will be available to discuss the situation. At the same time, except under unusual circumstances, the parent/guardian has a legal right to obtain this information. The parent/guardian will help ensure that therapy sessions are attended and will not inquire about the content of sessions. If the child prefers not to volunteer information about the sessions, the parent/guardian shall respect his/her right not to disclose details.

Understand that unless the child has been abused or is a clear danger to self or others, the counselor will normally tell both of the parent/guardian only the following: Whether sessions are attended - Whether the child is generally participating or not -Whether progress is generally being made or not.

The normal procedure for discussing issues that are in the child’s therapy will be joint sessions including the child, the counselor, the parent/guardian and perhaps other appropriate adults. If the parent/guardian believes there are significant health or safety issues that the counselor needs to know about, the parent/guardian should contact the therapist and attempt to arrange a session with the child present. Similarly, when the counselor determines that there are significant issues that should be discussed with the parent/guardian, every effort will be made to schedule a session involving the parent/guardian and the child.

If information becomes known to the counselor and has a significant bearing on the child’s wellbeing, the counselor will work with the person providing the information to ensure that both parents/guardians are aware of it. In other words, the counselor will not divulge secrets except as mandated by law but may encourage the individual who has the information to disclose it for therapy to continue effectively.

Diagnosis

Diagnoses are technical terms that describe the nature of your problems and something about whether they are short-term or long-term problems. If we do use a diagnosis, your counselor will discuss it with you. All the diagnoses come from a book titled the DSM-5; we have a copy in the office and will be glad to go over it with you.

 

 

MEDICATION MANAGEMENT

Many psychiatric disorders will require a two-pronged approach for successful treatment: medication combined with therapy/counseling. Medication management is a vital part of this equation, as not all medications will be received or tolerated by patients in the same way. Medication Management includes monitoring medications, their side effects, and their possible interactions with other medications.

What to Expect when participating in Medication Management

When you first see your medication provider, they will perform a first checkup called an assessment, which will include an overview of your symptoms and collection of your medical history. Based on this assessment, the doctor will then make a diagnosis and develop a treatment plan designed with your specific needs in mind. A determination will then be made about whether medication is an appropriate method for treating your mental health disorder. The decision is ultimately up to the patient. If it is decided to move forward with this choice, various medications, possible side effects, and proper dosages will be discussed. Initially, the medication will be prescribed for a trial period to observe and monitor its effectiveness. This is where the “medication management” part of psychiatric care comes into play. If the treatment meets the patient’s goals, the patient will be recommended to keep moving forward. However, different medications affect brain chemistry in different ways, so not everyone will respond well to a particular prescription.

This may result in side effects like the inability to sleep, irritability, nausea, and more. In those cases, a different medication will be prescribed. This is often a trial-and-error process that should eventually result in the right medication for you.

Best practice indicates that in conjunction with medication, counseling, life management skills, and behavioral interventions are very beneficial for best outcomes. It’s important to note that not all patients and not all psychiatric problems require medicine. However, there are many instances where prescription medicines are the best way to relieve symptoms for the patient. Medication can be an effective part of the treatment of many mental illnesses such as: Anxiety, Depression, Mood disorders, Sleep problems, ADHD, psychosis, and severe persistent mental illnesses.

Physician Services

Children’s Home Counseling Center and Training Institute employs one or more consulting physicians who provide medical support services (Medication Management) for our clients. Medication Management services are available, but clients must be in ongoing therapy and be referred by their therapist. One consultation with our physician is $60 per quarter hour (or $240 per hour).

All physician appointments are scheduled through the Front Office, with the frequency of appointments determined by the physician. Clients must be seen at least every 3 months in order to receive continued medication management. If clients no-show or late-cancel two appointments (including counseling sessions), medical services may be terminated.

Prescription Refills

One-week notice is required for prescription refills. Refills may be requested in one of the following ways:

1. You may ask your pharmacy for a refill request. Please fax the request to (208) 343-7797.
2. You may call the clinic and request an appointment or request to have the refill authorized.

The physician may request medical or psychological testing as part of their treatment. Clients are responsible for obtaining such tests and paying for any charges incurred as a result of these tests.

 

 

PSYCHOLOGIAL TESTING

Information About Testing Procedures

This assessment may involve evaluation of intellectual, academic, personality and/or emotional function. It will not involve any psychotherapy, medical procedures or medical treatment. Providing information about your background, family and/or child will be included in a clinical interview. Please speak with the testing clinician regarding specific instruments that will be used and tasks that will be required.

The information generated from the clinical interview and the testing results will be used to formulate a written report. The completed report will include the following: information about test performance, areas of strengths and weaknesses, diagnoses, possible modes of treatment and recommendations may be provided.

Our current fees range from $190 to $250 per hour. The length of time and the amount billed depend on the nature of the presenting problem and requested information. If you have questions, please speak with the testing clinician regarding the specific protocols to be administered. The fees include the time spent with the client, as well as time needed to score and write the evaluation.

Our services may be partly reimbursable under your health plan. In most cases, we will bill directly for services rendered. The insurance company will send the payment directly to us, but you will be responsible for any coinsurance payment, deductible, and any services deemed uncovered by the insurance company. There, if for any reason, your insurance company fails to pay the full amount expected, the responsible party will be required to pay the balance. Payment is expected at the time of your first appointment. Please speak with an office staff member regarding the types of insurance we accept.

 

INFORMATION DISCLOSURE STATEMENT

Therapy, Medication Management, and/or Psychological Testing offered through Children’s Home Counseling Services, is a relationship that works in part because of clearly defined rights and responsibilities held by each person. This frame helps to create the safety to take risks and the support to become empowered to change. As a client in counseling, you have certain rights that are important for you to know about, as well as certain limitations to those rights. As counselors, we have corresponding responsibilities to you. These are outlined as follows:

Confidentiality & Privacy

You are protected under the provisions of the Federal Health Insurance Portability and Accountability Act (HIPAA), as well as 42 CFR part 2. This means your records and private conversations while in program will be kept in strict confidence, even after you stop coming here for services. We may not say to a person outside the program that you attend treatment or disclose any identifying information about you unless the disclosure is allowed by court order, used for contractual audit, made to medical personnel for research or community health emergency, without your prior written consent. These laws also ensure the confidentiality of all electronic transmission of information about you.

Whenever we transmit information about you electronically (for example, sending bills or faxing information), we will do so with special safeguards to protect privacy. We may legally speak to another health care provider or a member of your family about you without your prior consent but will not do so unless the situation is an emergency. Additionally, your name and basic identifying data are submitted to a computerized billing system for billing purposes.

The following are legal exceptions to your right to confidentiality. We would inform you any time your counselor thinks they will have to put these into effect.

• If we have good reason to believe that you will harm another person, your counselor must attempt to inform that person and
• warn them of your intentions. We must also contact the police and ask them to protect your intended victim.
• If we have good reason to believe that you are abusing or neglecting a child or vulnerable adult, or if you give your counselor information about someone else who is doing this, we must inform Child Protective Services within 48 hours and Adult Protective Services immediately. If you are between the ages of 16 and 18 and you tell your counselor that you are having sex with someone more than five years older than you, or sex with a teacher or a coach, we must also report this to CPS, even though at age 16 you have the right to consent to sex with someone no more than five years older than you. Your counselor would inform you before your counselor took this action.
• If we believe that you are in imminent danger of harming yourself, your counselor may legally break confidentiality and call the police or the county crisis team. We are not obligated to do this and would explore all other options with you before taking this step. If at that point you were unwilling to take steps to guarantee your safety, we would call the crisis team.
• If you tell your counselor of the behavior of another named health or mental health care provider that suggests to your counselor that this person has either a. engaged in sexual contact with a client, including yourself or b. is impaired from practice in some manner by cognitive, emotional, behavioral, or health problems, then the law requires your counselor to report this to their licensing board. We would inform you before taking this step. However, if you are a client and a health care provider, your confidentiality remains protected under the law from this kind of reporting.
• If you tell your counselor, that you have expressed interest in sex transition procedures the counselor must, by law, notify the parent or legal guardian within seventy-two (72) hours of receiving any request by the minor to participate in or facilitate a social transition, including any request to use pronouns or names not corresponding to the minor patient’s legal name or biological sex, be referred to using names other than the minor patient’s legal name, or a nickname or derivative thereof, adopt appearance or dress that does not correspond to the individual’s sex (I.C. §32-1016(6)); and will not to aide or abet a social transition without first obtaining written parental consent.

Groups/Camps

During the psycho-educational process, you may also encounter unpleasant feelings or thoughts. You may also decide about changes you want to make in your behaviors and/or relationships. This experience may result in changes that were not originally intended.

During a psycho-educational process, your facilitators will draw on nature and farm assisted theory. Attending a psychoeducational process is not a substitute for individual psychotherapy or inpatient psychotherapy. If you require the names of counselors before, during, or after the psycho-educational process, your facilitator will be happy to provide you with a list of providers.

I understand that I am agreeing to participate in a psycho-educational experience that carries with it the potential for positive benefits and/or unpleasant feelings. I understand that I may experience both expected and unexpected changes.

I understand that this is not considered nor a substitute or alternative for individual/couple counselling and that I am free to participate in my own counselling during or after this experience.

I understand that this group experience will not provide emergency or crisis services. If needed, the facilitator can give a list of needed resources.

I also agree to practice self-care while participating in this group. If I am feeling overwhelmed, I will slow down or take a break and step away.

I understand that I am free to participate to whatever degree is comfortable for me. I will not push myself beyond that to meet any perceived expectations of myself or others.

Record-Keeping

We keep records of all your treatment activity, noting what interventions happened in session, and the topics discussed and any progress you have or have not made. All records will be kept in a manner consistent with HIPAA and 42 CRF part 2 for a minimum of 7 years post care. We maintain your records in a secure location that cannot be accessed by anyone else.

Where data storage and/or transmission of records requires a 3rd party platform (i.e.: software or server system), Children’s Home Counseling Services establishes and maintains a business associate agreement with these entities to ensure their adherence to HIPAA, as well.

AI Notetaking Assistant: The primary purpose of using QualifactsIQ is to enhance the efficiency, accuracy, and personalization of your care. It helps reduce administrative tasks, assist in decision-making, and provide relevant information. However, all outputs from QualifactsIQ are reviewed by your mental health provider to ensure they align with clinical expertise and your specific needs. QualifactsIQ processes information provided during your sessions, which may include sensitive health data. The following measures are in place to protect your information:

• All data is encrypted during transfer and storage, complying with HIPAA regulations.
• Information is used solely to support your care and is not used to train the AI model, sold to third parties, or used for marketing.
• Technologies comply with strict privacy standards, and Business Associate Agreements (BAAs) ensure third-party compliance.
• Your provider reviews all AI-generated content to confirm accuracy and appropriateness.
  • The recording will be deleted in 7 days from all systems automatically.

If you’re uncomfortable with us using this tool in your or your child’s sessions, please let your therapist know you wish to opt out and a form will be given to you to sign.

 

 

 MANAGED MENTAL HEALTH CARE 

If your therapy is being paid for in full or in part by a managed care firm, there are usually further limitations to your rights as a client imposed by the contract of the managed care firm. These may include their decision to limit the number of sessions available to you, decide the time period within which you must complete your therapy, or require you to use medication if their reviewing professional deems it appropriate. They may also decide that you must see another counselor in their network rather than yours. Such firms also usually require some sort of detailed reports of your progress in therapy, and on occasion, copies of your case file. We do not have control over any aspect of their rules.

However, we will do all that we can to maximize the benefits you receive by filing necessary forms and gaining required authorization for treatment and assist you in advocating with the managed care firm as needed.

Office Hours

Office hours are Monday-Thursday, 8:00am – 6:00pm and Friday 8:00am-5:00pm. You are welcome to call or email your counselor at any time. Please allow 48 hours for a return, as we are often with other clients.

Your counselor, psychologist, and/or physician may, at times, be away from the office for extended vacations, to attend professional meetings, or consulting with professional agencies. You should expect your provider to discuss any prolonged absences (longer than 3 days) with you well in advance and give you the name and phone number of a provider you can reach out to during their absence. Children’s Home staff are dedicated to the betterment of overall behavioral health in Idaho.

As a result, Children’s Home staff are involved not only in counseling and other mental health services, but in providing training and consulting to area providers. There may be times where, outside of a long absence, your counselor is unable to return calls as they may be conducting training or workshops. In these events, you may call the office and ask to leave a message and/or speak with another available provider.

Emergency Situations

Children’s Home Counseling Services is not a 24-hour care facility. We make every effort to see or talk to each person as soon as possible. However, if you are in crisis, have a medical emergency, or do not believe you can keep yourself safe please call 911 or go to your local emergency room.

Additional resources are also available to you:

Mental Health Crisis: 988

Idaho, Mental Health Crisis Line: 1-800-600-6474

Text concerns to 741741

Idaho Care Line: 211

Unattended Children

Please note that our office is not equipped to manage unattended children. Please arrange for childcare for the time of your sessions. If you need to bring your child to a session, this can be discussed on a case-by-case basis. Please understand that the content of therapy sessions is not always appropriate for your children to witness, nor does your child’s presence offer you the opportunity to focus solely on your needs in session.

Arrival Time/No-Shows/Cancellations

Please arrive at least 5 minutes prior to your scheduled appointment. All services have a specific time that is reserved just for you and early arrival allows us to use your time fully. Likewise, if you are a new client and have not completed your online intake packet prior to your appointment, please arrive 30 minutes early to fill out the new client packet prior to your scheduled appointment. In addition, if you need to cancel or reschedule your appointment please do so, at least, 24 hours in advance to allow us to meet the needs of another client.

Any late cancel or no-show to your appointment may be charged a no-show/late cancel fee from $50 to $80. There are extenuating circumstances, at times, which can be discussed and on rare occasions the fee may be waived. These waivers will be limited to sudden illness or transportation situations that may place you in danger (i.e.: icy roads, etc.). In the event a client does not show up (no-show) to a “standing” appointment, their recurring appointment will be removed from the schedule until such time as they contact their counselor to communicate their desire to continue therapy and all fees are brought current.

Court Testimony

We will testify in court only in response to a judge’s court order. Such time is not reimbursable by insurance and additional charges may accrue. In the event we are called to testify in a custody dispute, child protection case, etc., we will describe observable events only and may offer opinions only within the scope of licensure. We are not qualified as “custody evaluators” and will make this known to all court personnel as required by ethical obligation.

We do not advise or make recommendations with regard to parenting or custody arrangements. 

*Please read full court policy at the end.

Reasons for Termination ofCounselor-Client Relationship

You normally will be the one who decides when therapy will end, with these exceptions.

• If your counselor is not, in their judgment, able to help you because of limits to their training and specialty. In these cases, your counselor will discuss these limits with you and refer you to another counselor who may meet your needs.
• If you are not complying with or making progress toward treatment goals/objectives your counselor may discontinue treatment and offer you a referral to an alternate provider if you desire.
• If you are not meeting financial obligations, your counselor may terminate services and offer you a referral to a sliding scale/reduced rate program.
• If you are disruptive/inappropriate or abusive, it may require termination of treatment and recommendation to higher level of care.
• Dishonesty or deceitfulness may require termination of treatment and recommendation to higher level of care.

Complaints

If you're unhappy with what's happening in therapy, we hope you'll talk about it with your counselor so that they can respond to your concerns. Your counselor will take such criticism seriously, and with care and respect. If you believe that your counselor has been unwilling to listen and respond, or that they have behaved unethically, you can complain about their behavior to the Idaho Division for Occupational Licenses: 11351 W Chinden Blvd, Boise, ID 83714, (208) 334-3233 or file acomplaint here. 

For your counselor’s license numbers please visit our ""Our Clinicians".

 Your Rights

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

• Receive impartial access to treatment regardless of race, religion, gender, creed, color, national origin, age, sexual orientation, or disability.
• Be treated with dignity and respect
• Be free from abuse, retaliation, humiliation and neglect while receiving services.
• Participate in all aspects of your treatment plan and care.
• Ask questions about anything that happens in therapy or your counselor’s training and specialty.
• Decline or leave therapy at any time.
• You can ask to see or receive an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
• You can ask us to correct health information about you that you think is incorrect. We are not required to agree to your request, and we may say “no” if it would affect your care.
• There are multiple ways you and your counselor may communicate. These are: phone, email or secure client portal. You can ask us to contact you in a specific way.
• Share information with your family, close friends, or others involved in your care.
• You can ask us not to use or share certain health information.
• You can ask for a list (accounting) of the times we’ve shared your health information, who we shared it with, and why. We may charge a reasonable, cost-based fee.
• You can 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, 1-877-696-6775, or www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will need legal documentation to that effect.
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Your Responsibilities As a Client

• Arrive on time for your sessions. Sessions last for 30, 45 or 60 minutes. If you are late, your session will end on time and not run over into the next person's session.
• Pay all invoices for co-pays, no show, late cancel or late payment fees, upon receipt unless other arrangements have been made.
• If you no-show for two sessions in a row and do not respond to attempts to reschedule, we will assume that you have dropped out of therapy and will make the space available to another individual.
• If you are using insurance, you are responsible for providing us with your complete insurance identification information and obtaining the pre authorizations, if applicable.
• As a courtesy to you, our office will verify insurance eligibility and benefits. You are responsible for any fees you may incur, irrespective of insurance coverage, so it is important you know and understand your own benefits.
• If your insurance company mails a check to you directly, instead of us, you are responsible for paying that amount at the time of your next appointment.
• Participate fully in your care. The more you put into your counseling, the more you will get from it.

Our Responsibilities to You

• Treat you with dignity and respect.
• Maintain appropriate and healthy boundaries.
• We do not have social or sexual relationships with clients or former clients as this would be a gross abuse of power and is unethical.
• We are required by law to maintain the privacy and security of your protected health 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 it, if requested.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

 Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways.

Read more: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

• We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.
• We can use and share your health information to run our practice, improve your care, and contact you when necessary.
• We can use and share your health information to bill and get payment from health plans or other entities.
• Help with public health and safety issues such as:
  • Preventing disease.
  • Reporting adverse reactions to medications.
  • Reporting suspected abuse, neglect, or domestic violence.
  • Preventing or reducing a serious threat to anyone’s health or safety.
• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
• Respond to organ and tissue donation requests.
• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
• Address workers’ compensation, law enforcement, and other government requests.
• For law enforcement purposes or with a law enforcement official.
• For special government functions such as military, national security, and presidential protective services.
• We can share health information about you in response to a court order. In the event of a subpoena, we will share only the information about you necessary to respond with a request for a court order.

Non-Secure Communication

Communication with your provider through only secure means is highly recommended. Your fully secure transmission options are your client portal (which requires sign-in) We recognize that the use of secure services may create undue hardship to you as a client. Under HIPAA, you have the right to request communication with and from your counselor through unsecured means. This may include such patient health information related to scheduling and appointment times, billing, payment and claims information (not to include credit card numbers or diagnosis codes). Please discuss these options with your counselor and notify them of your choice. If you choose non-secured communication, please be aware that there certain conditions, under which your counselor may decide to terminate those options, such as, but not limited to the use of non-secured communication if it is determined by the therapist to put you at risk of harm or if you determined you would like to terminate your authorization for the use of these services.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request.

Reference: http://www.hhs.gov/ocr/privacy/hipaa/modelnotices.html

FEES AND PAYMENT POLICY AGREEEMENT

This document outlines office policies related to fees, insurance billing and payment. Please read it to understand both yourresponsibilities and those of Children’s Home Counseling Services, in regard to payment. Please feel free to discuss any questions or concerns you may have in session.

FEES AND SERIVICES

NO SHOW OR LATE CANCEL CHARGES:

LATE CANCELLATION – WITHIN 24 PRIOR TO SESSION TIME = $50

NO SHOW = $80

*** PAYMENT DUE AT TIME OF SERVICE***

BALANCE LIMIT

Please be advised that a $250 limit has been set for balances. If a balance exceeds $250 and is not addressed, services will be paused until the balance is taken care of. Please ask us about our Payment Plans and/or Subsidy application forms, if arrangements need to be made. While we will do our best to accommodate your scheduling preferences, we cannot guarantee that your original appointment time will be available if services need to be paused.

REGARDING PAYMENT/INSURANCE

Though we accept most insurances, we do not accept all insurances and not all services are billable to insurance so please check with your insurance company prior to your appointment to verify your benefits and coverage. If you desire to seekreimbursement through your insurance carrier, and your insurance carrier does not allow for out-of-network, you may want to contact their customer service department and ask for an exception so that you can be seen by the provider of your choice.

Many times, this will be granted on a provisional basis. All fees are tax deductible to you as a medical expense. Children’s Home Counseling Services will provide you with a receipt of payment upon request. Additionally, if you are paying out of pocket and wish to seek reimbursement from your insurance company you may request a “SUPERBILL” for services rendered. If you desire, we will bill your primary and secondary insurance, as long as you provide us with accurate information and your account is current. If you have an outstanding balance full payment will be required before further services can be provided. Benefits quoted are not a guarantee of payment. All payment is due at the time of service. You are responsible for fees regardless of insurance coverage. You are responsible for checking your insurance coverage. You are responsible for any deductibles, copayments, or balances applicable to your individual policy. If your insurance requires an authorization or referral for services, you are responsible for obtaining this referral. We realize that some individuals experience financial difficulties at times. If this occurs, please discuss this with your counselor.

Children’s Home Counseling Services cannot accept barter for therapy. We accept most major credit cards, checks or cash and HAS/FSA cards. Any uncollectible fees will be turned over to a collection agency, following 60 days. All collection agency fees will be the client’s responsibility.

 

ELECTRONIC COMMUNICATIONS AND SOCIAL MEDIA POLICY

Outlined below are Children’s Home Counseling Services office policies and practices related to the use of social media and technology. Please feel free to discuss any questions or concerns you may have in session.

Email: Children’s Home Counseling Services providers use a variety of ways to communicate with our clients. For many, email is the easiest and most efficient way to communicate, this cannot be assured throughout transmission. This means regular email communication is not completely secure or confidential. Any emails received from you and any responses sent to you become a part of your legal record.

Voicemail: Voicemail communication is considered confidential by HIPAA. Any voicemails received from you and any responses sent to you become a part of your legal record.

Text Messages: If you wish to have this service, please fill out the Text Message Consent form.

Social Media

Children's Home Counseling Services maintains public social media accounts to share information about our programs, services, events, and mental health resources.

You are welcome to follow or engage with our public social media pages. Please understand that any interaction with our public accounts (such as following, liking, commenting, sharing, or tagging) may be visible to others and could reduce your privacy or confidentiality.

To protect the therapeutic relationship and client confidentiality, our clinicians do not accept friend or connection requests from current or former clients through personal social media accounts.

As an organization, we do not use social media to communicate about clinical care or provide counseling services. If you need to contact your therapist or our office, please use the communication methods provided by your care team.

If you would like to discuss something you have shared online, or content you have seen that relates to your care, we encourage you to bring it up during your therapy session.

Internet Searches

As a general practice, Children's Home Counseling Services and its clinicians do not search for information about clients on the internet or through social media.

In rare circumstances involving an immediate safety concern, such as concern for a client's welfare when other reasonable efforts to make contact have been unsuccessful, publicly available information may be used to help ensure safety. Any such search would be documented in the client's record and discussed with the client whenever appropriate.

Location Services

Many smartphones and social media platforms allow users to share their location. If location sharing is enabled, others may be able to determine that you visited one of our offices. If protecting your privacy is important to you, we encourage you to review your device and app privacy settings and disable location sharing or check-ins while visiting our office.

Online Reviews

You may find Children's Home Counseling Services or our clinicians listed on websites such as Google, Yelp, Healthgrades, or other online directories. These listings may be created by the website and are not intended as a request for testimonials or endorsements.

We do not ask current clients to provide reviews or testimonials, consistent with professional ethical standards.

If you choose to post a review or comment online, please remember that these sites are public. Sharing information may reduce your privacy or confidentiality.

To protect client confidentiality, we will not respond to reviews or comments in a way that acknowledges or confirms whether someone is or has been a client. When appropriate, the organization may post a general response that does not disclose any protected health information.

 

 

SUPPLEMENTAL TELEHEALTH INFORMED CONSENT AND PRIVACY.

Definition of Services:

Telehealth is a form of psychological/substance abuse treatment service provided via secure internet technology which can include consultation, treatment, transfer of medical data, emails, telephone conversations and/or education using interactive audio, video, or data communications. Telehealth has the same purpose or intention as face-to-face treatment sessions. CHCS policies apply to this therapeutic arrangement. However, due to the nature of using technology in care, there are additional components to consider. These are outlined below.

Consent to Treat

You have the right to withhold or withdraw consent for Telehealth at any time without affecting your right to future care or treatment or without risk of retaliation.

Confidentiality and Privacy of Telehealth

The laws that protect the confidentiality of medical information also apply to teletherapy. However, communication via a 3rd party platform poses inherently higher potential risks to your confidentiality and privacy. When using a 3rd party platform, we establish and maintain a business associate agreement, ensuring these entities are adhering to HIPAA, as well. Despite our best efforts, it is possible that during the course of your exchange of information via technology, your information could be intercepted or interrupted by unauthorized persons. In the event of this occurrence, we will notify you immediately, take all steps in our power to recover and destroy the material, and correct any internal procedures that may have contributed to the breach.

Benefits & Risks to Telehealth

As with traditional face-to-face counseling, Telehealth has inherent benefits and risks. In addition to those mentioned for face-to-face care, specific benefits to Telehealth may be ease of access, increased flexibility in scheduling and feeling more comfortable in your own environment. The potential risks may include, but are not limited to the possibility, despite our most reasonable efforts, that the transmission of information could be disrupted or distorted by technical failures. Additionally, if the counselor comes to believe Telehealth to be negatively impacting your care, that your safety or mental health stability are at risk, they may refer you to face-to-face services or another higher level of care.

Reasons for Termination of Telehealth

You normally will be the one who decides when Telehealth will end. There are some exceptions to this, including, but not limited to: Connectivity or access issues & your counselor is concerned that the use of Telehealth is not appropriate for the level of risk to your mental health and/or personal safety.

Connectivity

There are times we may experience a technology failure during the course of a session, despite best efforts. In the event of a technology failure, your counselor will call you on the phone number you have provided to resume the session, or, if no time allows, to reschedule your session. If this interruption occurs during a crisis, as deemed appropriate by clinical standards, the counselor may utilize your Emergency Response plan and or/engage local mental health services to ensure your safety.

These may include:

• Contact the “emergency contact” provided at intake to provide your physical location for the purposes of your safety.
• Under the limits of confidentiality explained above, your counselor may notify local law enforcement or adult welfare agency to conduct a “welfare check."

Emergency Situations & After Hours

Telehealth is not a 24-hour or emergency service program. During our first session, we will discuss an emergency response plan. If you are experiencing a mental health emergency or do not believe you can keep yourself or others safe, please call 911 or proceed to the nearest hospital emergency room for help. See above for additional resources for an emergency.

Please keep in mind, our office hours, when engaging in telehealth, are the same as those outlined for in-person services. If

you need to reach your counselor after office hours, please leave a message or email and your counselor will get back with you within 24-48 hours unless other arrangements have been made.

Your Responsibilities as a Client in Telehealth

Your Device used for Telehealth:

• You are responsible for supplying your device - laptop or desktop computer are ideal.
• Headphones/earbuds can help reduce or eliminate echo and provide you additional privacy.
• Please make sure that you’re well-lit and that you don’t have a bright light source directly behind you.
• Ideally, your internet should be running at 384 Kbps or higher. If you’re unsure, discuss any connectivity issues with your counselor, they will help develop a plan.
• Close any other programs and close all other browser tabs, so that nothing is running in the background. (Ex: Skype, GoogleDrive, Facebook etc.)

Your Space During Telehealth:

• You are responsible for finding a private space, without interruptions, where you cannot be overheard. (Even if you “don’t mind” someone overhearing, this is not in your best interest. We MUST ensure your full privacy.)
• If you are concerned about interruptions or overhearing, some ideas may be:
  • Discuss it with your family and ask for privacy.
  • Lock the door.
  • Use a "white noise” machine or fan immediately outside the room you’re in.
  • Use your car, sit in the garage, or drive to a coffee shop/library to use their internet.
  • The use of headphones increases privacy so others cannot hear your clinician talking to you.

Your Safety with Telehealth:

• If you cannot ensure your privacy, or are concerned about your privacy, discuss a "code word” with your clinician, for use when you need to end a session abruptly. Your clinician will develop a plan with you.
• Notify us of your physical location at the start of each Telehealth session. In many states it is illegal for us to operate over state lines, so please know you MUST notify your counselor ahead of time if you are going to be out of state at the time of your session, so that plans can be made.

 

 

 

COURT ORIENTED ACTIVITIES AND FEES POLICY 

Legal/Custody and Subpoenas

Because our role is that of the child’s helper, we avoid getting involved in legal disputes or other official proceedings unless compelled to do so by a court of law. Matters involving custody and mediation are best handled by another professional who is specially trained in those areas rather than by the child’s counselor.

Please see our fee and payment schedule for costs. In the event we are ordered to participate in court proceedings, you are responsible for all the fees associated.

To provide services to minors we attempt to get approval from both parents/guardians or in the case of sole custody, a copy of the custody orders including parenting plan or any documentation related to decision-making or custody (guardianship, power of attorney, etc.). In the event we are unable to obtain parental consent from both parents we may or may not continue with therapy. This decision is at the discretion of the counselor and will be determined based on the child's best interest and legal/ethical parameters.

*Please note, we do not provide expert witness services for divorce, custody, or other legal disputes, unless directed to do so by a judge’s court order. In which case it must be known we are not certified custody evaluators.

A Release of Information must be fully completed and signed by all legal guardian(s) prior to releasing any information to the court and/or legal representatives.

Children’s Home Counseling Services/The Children’s Home Society of Idaho and their clinicians do not provide legal advice, home studies, or custody evaluations.

When seeking mental health treatment for your child(ren), you agree to not involve clinicians and interns who work at Children’s Home Counseling Services/The Children’s Home Society of Boise.

Children’s Home Counseling Services/The Children’s Home Society of Boise goal is to support children to achieve therapy goals, not to address legal issues that require a possible adversarial approach.

In the event a clinician is subpoenaed as a witness by a judge, fees for choosing to subpoena and requesting a counselor/intern will be $350 an hour, with a $3,500 non-refundable deposit (Card or Cashier’s Check) made no later than SEVEN (7) BUSINESS DAYS PRIOR TO THE COURT APPEARANCE. It is important to note that a subpoena is a significant disruption of the mental health treatment of other children and their families.

The rate of $350 includes driving to the courthouse and returning from the courthouse to the office and waiting at the courthouse. The time is billed in half hour increments.

IN ADDITION, RESEARCH AND PREPARATION, COMMUNICATION, INCLUDING REVIEW AND PREPARATION OF PAPERWORK WILL BE CHARGED AT THE RATE OF $250/HOUR.

When you submit a subpoena for testimony and/or paperwork these fees apply. If more than one party subpoenas the clinician/intern, the fees apply in full for each party separately and are not divided.

Records Request and Psychotherapy Notes:

UNDER NO CIRCUMSTANCES WILL PSYCHOTHERAPY NOTES BE RELEASED TO CLIENTS, PARENTS, THIRD PARTIES, OR MEDICAL PROVIDERS. THE ONLY EXCEPTION IS IF PSYCHOTHERAPY NOTES ARE ORDERED FOR RELEASE BY A JUDGE. JUDGE’S ORDER IS NOT THE SAME AS SUBPOENAS. PSYCHOTHERAPY NOTES ARE NOT PART OF THE CLIENT’S MEDICAL RECORD.

In accordance with the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

HIPAA provides special protections to certain medical records known as “psychotherapy notes.” Psychotherapy notes are defined under HIPAA as notes recorded by a health care provider who is a mental health professional (counselor/therapist) “documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual’s medical record.”

Excluded from the definition are the following:

• Medication prescription and monitoring
• Counseling session start and stop times
• The modalities and frequencies of treatment furnished
• Any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date. These documents are part of the client’s medical record.

A summary of treatment can be requested via a completed ROI and is at the discretion of the counselor/therapist/provider of the information provided. We (CHCS/Children’s Home Society of Idaho) will not disclose any information which may result in substantial harm to you or others.

 

CHCS Informed Consent and Privacy Policy Acknowledgment of Understanding.

By signing below, I agree that I have read and understand the full Informed Consent and Privacy Policies and consent of Children's Home Counseling Services. 

I may revoke my consent in writing except to the extent that the Practice has already made disclosures upon my prior consent. If I do not sign this consent, or later revoke it, the Practice may decline to provide treatment to me.