POLICIES & CONSENTS

SMALL STEPS POLICIES AND PROTOCOLS

 Therapy 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 psychotherapy, you have certain rights that are important for you to know about because this is either you or your child’s therapy, whose goal is your well-being. There are also certain limitations to those rights that you should be aware of. Small Steps reserves the right to update, and amend all policies and protocols as needed with or without notice to achieve best practices. 

OUR RESPONSIBILITIES AS YOUR MENTAL HEALTH PROVIDER

I. CONFIDENTIALITY

With the exception of certain specific exceptions described below, you have the absolute right to the confidentiality of your therapy. Small Steps cannot and will not tell anyone else what you have told your Small Steps therapist, or even that you are in therapy with Small Steps without your prior written permission. Small Steps will always act so as to protect your privacy even if you do release Small Steps in writing to share information about you. You may direct Small Steps to share information with whomever you chose, and you can change your mind and revoke that permission at any time.  

In many cases Small Steps therapists see multiple members of the same family. It is pertinent in the treatment process of this family for the therapists to coordinate care and develop treatment plans together with the family members. Interagency treatment coordination between therapists is necessary to provide optimal treatment for the whole family.  

 All Small Steps therapists are engaged in weekly or bi-weekly supervision with a member of the supervisory team. Client information may be discussed with any member of the supervisory team to support ethical and effective treatment of the client.

 You are also protected under the provisions of the Federal Health Insurance Portability and Accountability Act (HIPAA). This law insures the confidentiality of all electronic transmission of information about you. Whenever Small Steps transmits information about you electronically (for example, sending bills or faxing information), it will be done with special safeguards to insure confidentiality. If you elect to communicate with your therapist by email at some point in your work together, please be aware that email is not completely confidential. Any email Small Steps receive from you, and any responses that we will send to you, will be printed out and kept in your treatment record.

 The following are legal exceptions to your right to confidentiality.  The therapist will inform you of any time when we think we will have to put these into effect.

1. If the therapist has good reason to believe that you will harm another person, the therapist must attempt to inform that person and warn them of your intentions. The therapist must also contact the police and ask them to protect your intended victim.

2. If the therapist has good reason to believe that you are abusing or neglecting a child or a vulnerable adult, or if you give the therapist information about someone else who is doing this, the therapist must inform Child Protective Services or Adult Protective Services immediately.

3. If the therapist believes that you are in imminent danger of harming yourself, the therapist may legally break confidentiality and call the police. The therapist is not obligated to do this, and would explore all other options with you before they took this step. If at that point you were unwilling to take steps to guarantee your safety, the therapist would call the police.

 II. RECORD KEEPING

Small Steps keeps very brief records, noting only that you have been here, what interventions happened in session, and the topics discussed. You have the right to request that we make a copy of your file available to any other health care provider at your written request. Your records remain in a secure location that cannot be accessed by anyone else.

 Does a parent have a right to receive a copy of psychotherapy notes about a child’s mental health treatment?

No.  HIPAA defers to State Law in protection of Child Mental Health Records:  NMSA § 32A-6A-24(A) (2008) states that a treating entity requires a Release of Information for children 14 and over to release treatment information to caregivers.  For children under the age of 14, the treatment provider, defined as  “mental health or developmental disabilities professional” means a person who by training or experience is qualified to work with persons with mental disorders or developmental disabilities” can release a “summary of the child’s assessment, treatment plan, progress, discharge plan and other information essential to the child’s treatment” to the child’s personal representative unless the treating entity believes it would cause the child harm.  Nothing in State Law shall prohibit the denial of access to the records when a physician or other mental health or developmental disabilities professional believes and notes in the child's medical records that the disclosure would not be in the best interests of the child. § 32A-6A-24(G).

However, parents generally are the personal representatives of their minor child and, as such, are able to receive a copy of their child’s mental health information contained in the medical record, including information about diagnosis, symptoms, treatment plans, etc.    Further, although the HIPAA Privacy Rule does not provide a right for a patient or personal representative to access psychotherapy notes regarding the patient, HIPAA generally gives providers discretion to disclose the individual’s own protected health information (including psychotherapy notes) directly to the individual or the individual’s personal representative.  As any such disclosure is purely permissive under the HIPAA Privacy Rule, mental health providers should consult applicable State law for any prohibitions or conditions before making such disclosures.

Small Steps policy is to not disclose any psychotherapy notes without the express written consent of the client and/or client representative and to that end will only disclose records to other providers for continuity of care. All requests for records must be submitted in writing and will be processed within 30 days of the request. Small Steps does charge a fee for all records requested.

III. DIAGNOSIS

 If a third party such as an insurance company is paying for part of your bill, the therapist is normally required to give a diagnosis to that third party in order to be paid. 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, we will discuss it with you. All of the diagnoses come from the DSM-V.

 IV. OTHER RIGHTS

You have the right to ask questions about anything that happens in therapy. Small Steps Therapists are always willing to discuss how and why your therapist has decided to do what they are doing, and to look at alternatives that might work better. You can ask the therapist about their training for working with your concerns, and can request that they refer you to someone else if you decide they are not the right therapist for you. You are free to leave therapy at any time.

 V. 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, to decide the time period within which you must complete your therapy with your therapist, or to require you to use medication if their reviewing professional deems it appropriate. They may also decide that you must see another therapist in their network rather than your current therapist.  Such firms also usually require some sort of detailed reports of your progress in therapy, and on occasion, copies of your case file, on a regular basis. Small Steps does 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 authorizations for treatment, and assist you in advocating with the MC company as needed.

 VI. YOUR RESPONSIBILITIES AS A THERAPY CLIENT

Our standard fee for an initial intake session is $120.00 and an individual therapy session is $75.00 per 45-minute session, payable at the beginning of each session.  We are a provider for multiple insurances and all insurance billing will go through Therapy Notes. Co-pays can be made by check, credit card or cash (correct change is appreciated). Your checks are to be made payable to Small Steps Child Counseling. There will be a $35.00 service charge on all returned checks.

Please inform us if any problem arises during the course of therapy affecting your ability to make timely payments. Any services provided such as report writing, phone-consultations, or phone sessions that last longer than fifteen minutes will be billed on a prorated basis.

 Sessions last for 45- 50 minutes. If you are late, we will end on time and not run over into the next person's session. If your therapist is running behind you will receive the entire time of your scheduled session. If you cancel without 24 hours notice, you may lose your weekly time slot.

 If you have insurance, you are responsible for providing Small Steps with the information we need to send in your bill. You must pay Small Steps your deductible at the beginning of each calendar year if it applies and any co-payment at each session. Our insurance billing is completed in-house using Therapy Notes. Billing questions may be directed to our Business Operations Manager Kim Stout at (505) 349-5470.   

Should your patient balance exceed $200 we may suspend services until the account is brought current. If the insurance balance exceeds $500 we may suspend services to allow time for the outstanding claims to process. Should the account remain outstanding without payment arrangements for 60 days it will be sent to collections and a 20% fee added to the balance.

 VII. COMPLAINTS

If you're unhappy with what's happening in therapy, we hope you'll talk about it with your therapist so that we can respond to your concerns. We will take such criticism seriously, and with care and respect. If you believe that we have been unwilling to listen and respond, or that we have behaved unethically, you can complain about our behavior to the New Mexico Counseling and Social Work Licensing Board. You may also contact our Business Operations Manager Kim Stout (505) 349-5470.

 VIII. TELEPHONE & EMERGENCY PROCEDURES:

 Please feel free to leave a message for us at (505) 933-4639. Your call will be returned as soon as possible during regular business hours (9 a.m. - 6 p.m.). Messages are checked frequently during the day. Your call will be received within 24 hours even on weekends. Special arrangements can be made as needed for contact during periods of crisis. Your therapist will arrange for telephone coverage by a qualified therapist if they are out of town. In the event of a sudden emergency, please leave a message on our service clearly indicating that it is an emergency and also call 9·11 (Police/Ambulance) or proceed to your nearest emergency room for immediate assistance. 

IX. TERMINATION:

In initial meetings, we will assess whether our services can be of benefit to your child. We do not accept clients we do not believe we can help. In such a situation, we will provide you referrals to other therapists you can contact. If at any point during psychotherapy your therapist assess that the treatment is not effective in helping your child reach their therapeutic goals, the therapist is obligated to discuss it with you and, if appropriate, terminate treatment.

POLICY STATEMENT

What I Do:

          1.   Provide counseling for children, adolescents, couples, and families which supports mental health and family dynamics.

          2.   Recommend books, support groups, classes, and information for parents that may help with custody, visitation, and shared parenting circumstances.

          3.   For court-ordered clients, record and report the number of sessions attended, session dates, and client's involvement in therapy.

          4.   Report harm to self or others according to New Mexico Law.

 What I Do NOT Do:

          1.   Mediation

          2.   Get involved in the legal aspects of court cases or testify in court, except in special circumstances and with specific arrangements between myself and the judicial system.

          3.   Make recommendations for parenting time, custody or visitation for children in divorce and separation situations.

          4.    Evaluate a child for possible sexual or physical abuse or neglect.

RECORDS REQUEST POLICY

Small Steps keeps very brief records, noting only that you have been here, what interventions happened in session, and the topics discussed. You have the right to request that we make a copy of your file available to any other health care provider at your written request. Your records remain in a secure location that cannot be accessed by anyone else.

 Does a parent have a right to receive a copy of psychotherapy notes about a child’s mental health treatment?

No.  The HIPAA Privacy Rule distinguishes between mental health information in a mental health professional’s private notes and that contained in the medical record.  It does not provide a right of access to psychotherapy notes, which the HIPAA Privacy Rule defines as notes recorded by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the patient’s medical record.  See 45 CFR 164.501.   Psychotherapy notes are primarily for personal use by the treating professional and generally are not disclosed for other purposes.  Thus, the HIPAA Privacy Rule includes an exception to an individual’s (or personal representative’s) right of access for psychotherapy notes. See 45 CFR 164.524(a)(1)(i).

However, parents generally are the personal representatives of their minor child and, as such, are able to receive a copy of their child’s mental health information contained in the medical record, including information about diagnosis, symptoms, treatment plans, etc.    Further, although the HIPAA Privacy Rule does not provide a right for a patient or personal representative to access psychotherapy notes regarding the patient, HIPAA generally gives providers discretion to disclose the individual’s own protected health information (including psychotherapy notes) directly to the individual or the individual’s personal representative.  As any such disclosure is purely permissive under the HIPAA Privacy Rule, mental health providers should consult applicable State law for any prohibitions or conditions before making such disclosures.

Small Steps policy is to not disclose any psychotherapy notes without the express written consent of the client and/or client representative and to that end will only disclose records to other providers for continuity of care. All requests for records must be submitted in writing and will be processed within 30 days of the request. Small Steps does charge a fee for all records requested.

CONSENT FOR EMAIL AND/OR TEXT MESSAGE COMMUNICATION

Email and text messaging allows Small Steps Child Counseling health care providers to exchange information efficiently for the benefit of our patients. At the same time, we recognize that email and text messaging are not a completely secure means of communication because these messages can be addressed to the wrong person or accessed improperly while in storage or during transmission.

You are not required to authorize the use of email and/or text messaging and a refusal will not affect your health care in any way.

If you prefer not to authorize the use of email and/or text messaging we will continue to use U.S. Mail or telephone to communicate with you. Please send an email to us indicating you do not want to receive email or text communications.