TECHNOLOGY POLICY
It is highly preferable to use a computer or iPad as the large size screens allow for a more connected and engaged therapy experience. This is especially important for couple or family sessions. In addition, I recommend that you keep an alternative device (e.g., phone) available for use in the event of a technological failure. Please make sure to charge your devices in advance.
If disconnection occurs during a session, wait 30-60 seconds to see if you are able to reconnect. If not, please sign out and then try to sign in again. If, after five minutes, you are still not able to reconnect, please send me a message through your client portal to discuss next steps. Note -changes in location during a session – for example, moving from room to room in your home or driving or re-parking if you are in your car, may cause freezing or disconnection, and you will need to sign out and sign in again to regain a connection without freezes or delays.
SOCIAL MEDIA POLICY
HIPAA-Compliance To maintain the highest level of privacy, confidentiality and safety for all clients, Gardin Counseling uses a HIPAA-compliant practice platform (Simple Practice) for all teletherapy sessions, communications and client records. If you choose to interact with your telehealth provider outside of the Simple Practice HIPAA-compliant system, please be aware that other platforms or methods of communication may not offer the same level of confidentiality and privacy.
Secure Messaging The most secure and confidential method for interacting with your telehealth provider is through the Simple Practice secure messaging system in your client portal. Gardin Counseling uses Simple Practice because it is a fully HIPAA-compliant system. Gardin Counseling asks that all clients use the Simple Practice secure messaging when communicating with their telehealth provider or Gardin Counseling. the event of time-sensitive or emergency matters, including last minute appointment cancellations, direct email ([email protected]) is a second-best option.
Voicemail If, for some reason, you are unable to use secure messaging through your client portal, or you have a matter to discuss that is urgent or time-sensitive, you may leave a message on the Gardin Counseling voice mail (424-248-8790). Please be aware, however, as your telehealth provider may not be in the same time zone as you, there may be a significant delay (24-48 hours) before your telehealth provider can respond.
Email As email is not a secure or confidential HIPAA-compliant platform, please limit your use of email to arranging and/or modifying appointments only. Do not use email to discuss content related to therapy sessions. If you choose to communicate with your telehealth provider by email, please be aware that all emails are retained in the logs of both Internet service providers (yours and Gardin Counseling’s), and while it is unlikely that anyone will look at these logs, they are theoretically readable by system administrators of both internet service providers. This is not something Gardin Counseling has any control over. You should also know that any email correspondence you send to your telehealth provider and any responses that are sent back to you by your telehealth provider can become part of your legal record and will be included in your Simple Practice notes if the content is relevant to your therapy process.
Texts Please do not use SMS (mobile phone, What’s App) or messaging on social networking sites such as Twitter, Facebook, or Linked-In) to communicate with your telehealth provider with words or photos. These sites do not offer the same level of HIPAA compliance as secure messaging in the Simple Practice platform and can potentially compromise your confidentiality. More importantly, your telehealth therapist may not routinely check text messages and most likely will not see your message in a timely fashion. Finally, text messages can become part of your legal record and will be included in your Simple Practice notes if the content is relevant to your therapy process.
Friending & Following Due to the importance of your confidentiality and minimizing dual relationships, your telehealth therapist will not communicate with you with through Facebook, Twitter, Instagram, or Linked-In. Your telehealth provider will not accept friend or contact requests from current or former clients on social networking sites nor do follow clients on social media as these types of interactions are known to blur the boundaries of the therapeutic relationship and negatively impact the work of therapy. If there are things from your online life that you wish to share with your telehealth provider, please bring them into our sessions where the two of you can view and explore them together during your therapy session.
Search Engines Your telehealth provider will not routinely search for clients on Google, Facebook or other search engines. Extremely rare exceptions may occur during times of crisis, e.g., if your telehealth provider has a reason to suspect that you are in danger or that you may potentially endanger the lives of other persons and you have not been in touch with your telehealth provider through usual contact methods for a period of time. This would only happen in unusual circumstances and if your telehealth therapist ever resorts to such means, s/he will document it and discuss it with you when you next meet.
Business Review Sites You may find your telehealth provider or Gardin Counseling listed on sites such as Yelp, Healthgrades, etc. Many of these sites use search engines to locate and automatically add therapist listings regardless of whether the provider or business has made a request to be listed. If you choose to submit comments, ratings or endorsements, please keep in mind that you may be sharing personally revealing information about yourself in a public forum. Please understand that, to maintain your confidentiality, your telehealth provider cannot respond to any review, whether is positive or negative. Most importantly, for your sake, you are strongly encouraged to bring all of your thoughts and feelings about your therapy work (positive or negative) directly into the therapy process so that you and your telehealth provider can discuss these in a safe and non-judgmental setting. This can be an important part of therapy.
Location-Based Services If you have GPS tracking or any LBS service enabled on your mobile phone or other device, it is possible that others may surmise that you are a therapy client if you check-in on a regular (e.g., weekly) basis (for in-person visits only.)
Updates As new technology develops, there may be times when Gardin Counseling needs to update this policy. If so, you will be notified in writing of any policy changes and receive a copy of the updated policy.
Conclusion Thank you for taking the time to review this Social Media Policy. If you have questions about any of these policies and procedures, please feel free to reach out to Gardin Counseling to discuss.
CONFIDENTIALITY and PRIVACY POLICIES
The information disclosed by you, as well as any record created of it, is subject to therapist-client privilege. The therapist-client privilege results from the special relationship that exists between you and your therapist in the eyes of the law. This privilege means that your therapist will not disclose confidential information about your treatment without a signed authorization and waiver (“PHI”) from you regarding the release of information. That being said, in situations involving couple and family therapy, it is not the therapist’s role to act as a “holder of secrets,” and the therapist will encourage the sharing of information in a manner that supports healthy relationships.
If your therapist sees you unexpectedly outside of the therapy office, s/he will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance, and your therapist does not wish to jeopardize your privacy. If you acknowledge the therapist first, s/he will be more than happy to speak briefly with you. It is not appropriate, however, to engage in any lengthy discussions in public or outside of the therapy office.
Occasionally a therapist may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you, and information about you may be shared in this context without using your name. In addition, under Federal HIPAA regulations, psychotherapy records can be released by the therapist to the insurer without patient’s written authorization.
If your therapist receives a subpoena for records (see definition below), deposition testimony, or testimony in a court of law, s/he will assert the therapist-client privilege on your behalf until instructed in writing to do otherwise by you or your legal representative, unless such privilege has been waived previously by you in a written and signed authorization. You should be aware, however, that if you make your mental or emotional state an issue in a legal proceeding, you might be waiving your therapist-client privilege. As Gardin Counseling is not qualified to provide you with legal advice, this is a matter that you should discuss with your attorney or legal counsel. You should address any concerns you might have regarding this issue or other issues relating to therapist-client privilege with your attorney or legal counsel.
Psychotherapy records are considered confidential documents and may include, among other things, your intake form, informed consent, authorizations for release and/or exchange of information, office policies, fee, payment and billing information, counseling session dates, diagnoses, mental health status, modalities of treatment, frequencies of treatment, symptoms, prognosis, therapist impressions, treatment plans, and progression to date. Psychotherapy records are written in accordance with the best clinical judgment of your therapist and cannot be modified or changed at the request of the client, client’s attorney, family members, friends or anyone else related to or not related to the client for any purpose, including purposes related to litigation and/or custody disputes. You or your legal representative have a right to right to request copies of your records. Such a request must be made in writing and include the date, specific records requested or excluded, reason for said request, your signature, contact information, and address or email address where the records are to be sent. Gardin Counseling may respond to said request by providing a full copy of your record or summary of your record with said decision made at the discretion of your therapist in accordance with his/her best clinical judgment. Gardin Counseling may also deny your request if, in the determination of your telehealth provider there is a “substantial risk of significant adverse or detrimental consequences to the patient in seeing or receiving a copy of his/her record.” Gardin Counseling has the right to charge a reasonable fee for locating and preparing your records or summary, including costs for preparation, printing, copying and transmittal services.
A Federal law known as The Patriot Act of 2001 requires therapists (and others), in certain circumstances, to provide Federal agents with books, records, papers, documents and other items with or without a subpoena. In addition, the law prohibits the therapist from disclosing to the client that the Federal agents sought or obtained the items under the Act.
Other specific limitations of client-therapist privilege and confidentiality exist and are itemized below: 1) If a client threatens or attempts to commit suicide or otherwise conducts him/her self in a manner in which there is a substantial risk of incurring serious bodily harm. 2) If a client threatens grave bodily harm or death to another person. 3) If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years. 4) Suspicions as stated above in the case of an elderly person who may be subjected to these abuses. 5) Suspected neglect of the parties named in items #3 and # 4. 6) If a court of law issues a legitimate subpoena for information stated on the subpoena. 7) If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.
Gardin Counseling and your therapist will not voluntarily participate in any litigation, custody disputes, or disability claims or appeals, which you and another individual or entity, including federal, state and city governmental agencies, are parties, nor communicate with your attorneys, write or sign letters, reports, declarations, or affidavits to be used in a legal manner, nor provide records and/or testimony unless it is agreed upon at the beginning of the therapeutic relationship and you provide Gardin Counseling with a written Authorization signed by you that fully waives client-therapist privilege and specifically directs Gardin Counseling to produce such records, communications and/or documents for the purposes of litigation and/or custody disputes, or such action is compelled by subpoena or other legal order. In either case, therapist will use his/her best clinical judgment in responding to such requests and you agree not to hold the therapist and Gardin Counseling responsible or liable for the impact of the release of such records, communications and/or documents on the success or failure of your litigation, custody dispute, or any other impact that may affect you personally or professionally. At no time is a client allowed to request a change in documentation or records so as to better suit his/her litigation purposes, and in any such request, if made, will be denied. Should a therapist for Gardin Counseling be subpoenaed or ordered by a court of law to provide documentation or records, or appear as a witness in any action involving you, you agree to reimburse the therapist for any time spent for preparation of documents or testimony, travel or other time which is made available for such an appearance, consultation with attorneys, and writing or signing documents, declarations or affidavits as it relates to your litigation or custody dispute at an hourly rate to be determined by Gardin Counseling which may be equivalent to or greater than the hourly rate for your counseling sessions.
PERSONAL AND FINANCIAL RESPONSIBILITIES AND CANCELLATION POLICIES
Therapist Responsibilities include being available at the time and day scheduled for your appointments, adhering to the highest standards of professional care at all times, providing a safe and welcoming therapeutic environment, and supporting you through your unique journey of exploration and healing.
Client responsibilities include keeping all scheduled appointments, remaining compliant with all medications prescribed by your psychiatrist and other treating physicians, promptly notifying Gardin Counseling of changes in your medications, physical or mental health status, contact information (phone, email, mailing address, location for teletherapy sessions), primary care provider, psychiatrist and/or emergency contacts, and enrollment in outpatient recovery programs and/or hospitalizations, and reading, understanding and complying with all Gardin Counseling practice policies, including those relating to fees and cancellations.
Regularly Scheduled Sessions
Weekly sessions (same day/time) lead to the best therapeutic results and are strongly recommended. When clients do not engage in regular therapy sessions, the chances of achieving their goals are significantly diminished. As our goal is to help all clients achieve the highest level of success, we do not offer therapy for clients who are unable to maintain a regular therapy schedule.
Emergencies
Gardin Counseling is not a 24-hour crisis-intervention service. In the event of an emergency, please call 911 or go to the nearest emergency room for treatment.
Fees
Gardin Counseling maintains a strict fee schedule depending on the complexity of the case and type of therapy required. In addition to therapy sessions, clients may be charged in 15-minute intervals, for other services, including email correspondence, report writing or review, preparation of legal and/or insurance documents, and consultations with other service providers on a client’s behalf. Please note that therapy cannot be conducted via email. For on-site services, travel time charges are accrued at the client’s regular session rate.
All clients are required to keep a credit card on file with Gardin Counseling, and charges will be put through for all services 1-5 days following provision of the services. Acceptable forms of payment include Visa, Mastercard, American Express and HSA cards. Note – If you ever feel you have been charged in error, please Gardin Counseling ([email protected]) to discuss as soon as possible.
Financial Responsibility
Part of the work of therapy is becoming empowered to make important choices about how you conduct your life and to take responsibility for these choices. This includes making the choice to engage in the work of therapy and assuming responsibility for paying all fees related to your therapy All clients are required to keep a credit card on file with Gardin Counseling. Session fees are due and payable at the time of service and will be charged to this credit within one to five days following your session. If your credit card is declined, you will be notified and must provide an alternative method of payment within 24 hours to avoid a late fee (15% of the balance). If your card is repeatedly declined, your therapy may be terminated, at which time the balance must be paid in full to avoid having your account sent to a collection agency.
Parents or legal guardians are financially responsible for treatment of minor children <18 years of age. Parents and legal guardians can accept responsibility for treatment of adult children by signing the financial responsibility documents that are part of the intake package.
Cancellations
Therapy is successful when clients commit to regular sessions and clients who frequently cancel sessions are unlikely to make progress. Cancellations almost always negatively impact the therapeutic process. Cancellations also affect other clients as you may be taking up a session that could have been offered to another client. As such, cancellations are strongly discouraged.
Cancellations must be made in writing by emailing the practice ([email protected]) and/or using secure messaging in your client portal. No other methods, including text, are acceptable. If you do not receive confirmation from Gardin Counseling within 2 hours, that your cancellation message has been received, please resend it as soon as possible.
In the event your cancellation is related to an emergency, we will try to reschedule you for the same week, but there is no guarantee that this accommodation can be made.
If you are holding a standing weekly session and cancel twice in a row, you may be moved to “as available” scheduling. If you cancel sessions frequently, your treatment may be put on hold or terminated. If your therapy is terminated, I will try to offer you a referral, but I cannot guarantee this.
It is your responsibility to read and follow all cancellation policies. You will be charged for any cancellations per the fee structure below:
≤24 hours in advance: 100% of session fee
24-36 hours in advance: 75% of session fee
37-48 hours in advance: 50% of session fee
*Appointments on holidays or holiday weekends must be cancelled ≤72 hours in advance to avoid a 100% session fee. No shows are considered last minute cancellations and will be billed at the full session rate.
Insurance, Third-Party Payers and Superbills
Gardin Counseling is not associated with any insurance programs or third-party payers, and you are responsible for payment in full for all services you receive from Gardin Counseling. In addition, Gardin Counseling cannot submit documents on your behalf to insurance companies or third-party payers, nor accept direct payments from these entities. That being said, if requested by you, and as long as you are current in your payments and maintain a zero balance on your account, Gardin Counseling will provide you with a monthly Superbill that you can choose to submit to your insurance company or third-party payer for reimbursement. While most clients with out-of-network benefits are successful in submitting for reimbursement by their insurance companies, Gardin Counseling is not responsible if your insurance company or third-party payer rejects a request for reimbursement and makes no guarantees as such. Also, please be advised that Superbills contain confidential information including your ICD diagnosis code(s) and CPT codes that describe the type of sessions for which you are requesting reimbursement. In addition, insurance companies or third-party payers may, at times, request copies of your full client records as a condition for reimbursement. Gardin Counseling cannot routinely engage in this type of additional correspondence, except in rare circumstances, in which case you will be charged an administrative fee calculated at the same rate as your session fee for the total time involved in preparing and sending such documentation.
Financial Responsibilities for Minor Clients and Other Family Members
If you are accepting financial responsibility for treatment by Gardin Counseling for your child, adult child or any family member (hereafter “family member”), you are responsible for informing your family member about client responsibilities and cancellation fees. If you or your family member fail to cancel an appointment or family member fails to show for a scheduled appointment, you are still responsible for payment of the session and/or cancellation fees according to the cancellation fee schedule above.
Termination of Therapy
Your therapist has the right to terminate therapy at his/her discretion. Reasons for termination include, but are not limited to, untimely payment or non-payment of fees, failure to comply with treatment recommendations, conflicts of interest, dual relationships, failure to participate in therapy, or if your needs fall outside of the scope of competence or practice, or if the therapist believes that you are not making adequate progress in therapy. Your therapist also has the right to terminate therapy immediately upon any actual or implied threats to therapist of physical, psychological, professional, or financial harm by you or individuals whom you direct to make such threats or who make such threats on your behalf, whether in oral or written form. Further, therapist has the sole determination as to whether such threats rise to a level of concern that merits termination of therapy. You have the right to terminate therapy at your discretion. Upon either party’s decision to terminate therapy, your therapist may recommend that you participate in at least one, or possibly more, termination sessions. These sessions are intended to facilitate a positive termination experience and give both parties an opportunity to reflect on the work that has been done. To promote a smooth transition, your therapist will attempt to provide referrals to you, but this may not always be possible. You agree that you will not at any time disparage or denigrate your therapist or Gardin Counseling, or encourage or induce others to do so, or issue any communication, written or otherwise, that reflects adversely on or encourages any adverse action against your therapist or Gardin Counseling. This includes any statement to the press or media, whether written or verbal, electronic or otherwise.
TELETHERAPY INFORMATION AND POLICIES
The following information is provided so that you will understand the risks and benefits of teletherapy.
Telehealth is a mode of delivery of health care services using information and communication technologies to facilitate diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site.
Telehealth has potential benefits, including easier access to care, reduction of lost work time and travel costs, the convenience of meeting from a location of my choosing, and the ability to remain within support networks.
Telehealth has potential risks technology, including interruptions, unauthorized access, and technical difficulties.
Telehealth differs from direct patient/health care provider sessions since the patient is not in the same room as the provider, and the comfort level with this platform may vary from patient-to-patient and session-to-session.
All clients are obligated to provide their telehealth provider with a full and accurate medical and psychiatric history as a condition of receiving telehealth.
Confidential information is best communicated in-person and that the confidentiality of information communicated through technology, including video, email and text, cannot be guaranteed.
Telehealth is not an emergency service, and in the event of any life-threatening emergency, clients must contact 911 or go to the nearest emergency medical facility for evaluation and treatment.
On rare occasions, your telehealth provider may perceive that a client in a life-threatening situation and recommend that you seek immediate care at the nearest emergency medical care facility. If this situation occurs, the client must agree to follow his/her telehealth provider’s recommendation and seek such treatment without delay.
All existing laws regarding patient access to medical information and copies of medical records apply to telehealth.
Telehealth providers will not knowingly disseminate any patient-identifiable images or information from the telehealth interaction without the client’s consent and all clients must agree to not knowingly disseminate any telehealth provider images or information from the telehealth interaction to other individuals or entities without the consent of his/her provider and Gardin Counseling.
The recording of teletherapy sessions is a violation of HIPAA rules and is antithetical to the trust-building process necessary for safe and effective therapy. As such, it is strictly prohibited to record or cause to be recorded any in-person, phone or video teletherapy sessions including, but not limited to photography, screen shots, audio-recording and/or video-recording, and/or to transcribe or cause to be transcribed such recordings. Should a client purposely or inadvertently violate this rule, the client must inform his/her telehealth provider and immediately destroy or cause to be destroyed all said recordings and/or transcripts. If the client has provided other individuals or entities with copies of said recordings and/or transcripts, the client must provide his/her telehealth provider with a list of names and contact information (phone, email and mailing address) for all parties; the client will immediately notify all parties in writing that said recordings and/or transcripts must be destroyed and will copy Gardin Counseling on all related correspondence, including confirmation that said materials have been destroyed. Should a client purposely or inadvertently record or cause to be recorded any in-person, phone or video teletherapy sessions, the client forfeits at that time and until the end of time, the use of said recordings and/or transcripts for any and all purposes including media, social media, and any and all formal proceedings, including, but not limited to legal proceedings and/or proceedings involving professional or licensing boards.
Prior to the start of treatment, all clients must affirm that they do not have at this time or in the past any physical or mental health condition(s) that would make them inappropriate candidates for telehealth, including, but not limited to, substance use, domestic violence, severe mental illness, including personality and eating disorders, previous episodes of psychosis, suicide attempts, cutting behaviors, or hospitalizations for a psychiatric condition, and a history of or involvement criminal activity including, drug trafficking, previous incarceration, or commitment of a felony.
The provision of telehealth is always at the discretion of the telehealth provider Factors the telehealth provider may consider in determining the appropriateness of a patient for telehealth include, but are not limited to, the patient’s diagnosis, cognitive capacity, history regarding cooperativeness with other treatment professionals, current and past difficulties with substance use or addiction, emotional stability, medication status, availability of in-person psychiatric consultation, a history of violence or self-injurious behavior, history of hospitalization or institutional confinement, efficacy of patient’s support system, and current medical status.
The telehealth provider must assess a client’s fitness for telehealth at the start of every session, and if therapy is contraindicated, the session will not proceed further, and may or may not be rescheduled.
If the telehealth provider determines that a client is no longer an appropriate candidate for telehealth, therapy will be terminated. The telehealth provider may attempt to identify a local provider, but cannot guarantee a referral.
Any client can decide to withdraw consent for telehealth at any time without affecting his/her right to future care or treatment nor risking the loss or withdrawal of any program benefits to which the client would otherwise be entitled.
For telehealth to be effective, the location where the client is located must be private and have the capability for clear transmission of video-conferencing. If a client chooses to use public wi-fi , this may compromise the privacy of his/her protected health information, and, therefore, all clients are advised to use private wi-fi for all sessions and communications with their therapist.
Telehealth providers can decide, at their discretion to temporarily or permanently discontinue telehealth sessions if s/he believes that videoconferencing connections are not adequate for the situation.
For telehealth to be effective, clients must fully attend during the session. Simultaneously engaging in other activities or multi-tasking during a session will reduce the effectiveness and success of the therapy, and may result in the termination of telehealth by the telehealth provider.
All clients are required to provide my health care provider with their location (street address, apartment number, city, state, zip code) and the name and phone number of the closest emergency medical facility at the start of each teletherapy session or to affirm that this information has not changed since the previous session.
It is the responsibility of the client to choose a location for his/her teletherapy appointments that is within the geographical area in which his/her telehealth therapist is licensed, and his/her therapist is unable to assume any liability for the client’s care if the client chooses to locate him/herself to outside of the area and fails to disclose this to his/her therapist at the start of the session. All clients are obligated to provide their telehealth provider with contact information (name, phone number, email) for a Patient Support Person (PSP). The PSP can be a family member, friend or other person who is located within a reasonable distance from the location where the patient is situated for telehealth sessions and can be called upon for support in the case of emergency.
All clients must agree that their telehealth provider can contact their PSP to request assistance in evaluating a possible emergency and/or initiating a 911 call on behalf of the client. If, at any time, a designated PSP becomes unable or unwilling to serve in this capacity, the client must immediately provider his/her telehealth provider with the name and contact information of a new PSP.
All clients must notify their telehealth provider within 24 hours of any change in their physical or mental health including, but not limited to changes in diagnoses and medications, visits to urgent care facilities, and hospitalizations.
Client receiving telehealth services with Gardin Counseling must maintain a credit card on file with Gardin Counseling and agree to have fees for sessions charged to that credit card within 24 hours of my session. If a card is declined, the client must provide a new card within 24 hours. Multiple card declinations will result in termination of therapy, at which time all fees will be immediately due and payable, and no referral will be offered.
Any client who has questions about any aspect of this policy is encouraged to discuss this with their telehealth provider .