Practice Policies.

 

CONFIDENTIALITY:  I acknowledge I have received a copy of the Confidentiality of Patient Records and was given the opportunity to read and ask questions regarding Confidentiality practices.

A.  Information disclosed to the treatment professional is a privileged communication and cannot be disclosed in any civil or criminal court proceeding without the consent of the client or a valid court order.  However, under Idaho Rule of Evidence 517 (d), there is no privilege for the following acts:

1.  Civil Action.  In a civil action, case or proceeding by one of the parties to the confidential communication against the other.

2. Proceedings of guardianship, conservatorship, or hospitalization.  As to a communication relevant to an issue in proceedings for the appointment of a guardian or conservator for a client for mental illness or to hospitalize the client for mental illness.

3.  Child related communications.  In a criminal or civil action or proceeding as to a communication relevant to an issue concerning the welfare of a child including, but not limited to the abuse, abandonment, or neglect of a child.

4.  Licensing board proceedings.  In an action, case, or proceeding under Idaho Code 54-3404.

5.  Threats of harm to yourself or others, contemplation of crime or harmful act.  If the communication reveals the contemplation of a crime or harmful act.

B.  The Health Insurance Portability and Accountability Act of 1996 provides additional protection of your private treatment information.  You will be provided a separate Notice of Privacy Practices information form that details those protections and safeguards.

C.  Under CFR 42, Chapter 1, Part 2, Section 2.51, identifying information may be disclosed to medical personnel who have a need for information about you for the purpose of treating a condition which poses an immediate threat to the health of any individual and which requires immediate medical intervention.

I understand that confidentiality extends to other clients in the treatment setting.  I understand I cannot discuss with those outside of my treatment setting any identifying information of those I meet, see, and hear about during my treatment episode including names, physical descriptions, or stories which may be common knowledge to those outside of treatment thereby identifying the individual being discussed.  I understand my confidentiality is protected by law and understand the exceptions to the requirement of confidentiality.

COUNSELING PROCESS: The purpose of my participation in treatment is to acquire knowledge, skills, and attitudes supportive of a more satisfying lifestyle. In addition to the potential positive outcomes likely to occur as a result of my participation, I understand the following reasonably foreseen risks may occur as they would in any counseling or treatment program: breach of confidentiality; negative reactions of group members; emotional stress from requirements of group interaction; self disclosure; stress to relationships from open discussion of issues, past traumas, or stress to relationships resulting from behavior changes (positive or negative). time spent in sessions, time spent in the recovery community, or time spent completing homework. I understand the potential risks and benefits from my participation and I voluntarily give my consent to receive counseling and treatment.

ChangePoint is a traditional treatment program based on community self-help groups, 12-step recovery and/or community support alternatives. The therapeutic orientation, modalities, and treatment utilized by this agency and staff involve cognitive therapy and motivational enhancement therapy techniques. Treatment includes individual and group sessions. The techniques will include education, identification of cognitive processes, developing intervention and refusal skills, recognizing personal accountability. These processes may produce feelings that are uncomfortable. Such feelings are normal and should dissipate as the process continues. The techniques utilized by our counselors may be directive and are solution oriented. You have the right to seek a second opinion and to terminate services at any time.

I agree to follow the group rules. I agree to attend all group and individual sessions and be punctual to all sessions. I agree to actively participate in all sessions. I agree to provide correct and valid information. I agree to complete all assignments given to me by a counselor or group facilitator. I agree to bring all workbooks with me to each session that requires workbooks. I agree I will not attend any counseling or group sessions while under the influence of any mood-altering substances,. I understand I can be terminated from services for failure to comply with this agreement and that termination will be reported to certain referral sources.

This agency is a for profit agency. Our sources of funding include client payments, insurance reimbursements, and fees or services rendered from contractual agreements. The quantity and duration of services are not limited but may be subjected to fee reimbursement limitations based on your insurance plan or if you are supervised by any correctional or judicial entity.

I hereby acknowledge that I have reviewed, been given a chance to clarify, and been offered a copy of:

  • Notice of Privacy Practices and Confidentiality of Alcohol and Drug Abuse Patient Records

  • Communicable Disease Testing Referral Information

  • Client Rights or OPTUM Client Rights and Member Responsibilities

  • Notice of Family Involvement

COUNSELING STAFF:

Beverly Fowler, LPC, ACADC Executive Director, owner, is an  Advanced Certified Advanced Alcohol and Drug Counselor and is a Licensed Professional Counselor. She has a Master’s Degree in Counseling Psychology from Lewis & Clark College in Portland Oregon, 1991.

Dennis Gray, BS, ICADC owner, married to Beverly Fowler, is an Internationally Certified Alcohol and Drug Counselor. He has a Bachelor’s Degree in Communications from Lewis-Clark State College in Idaho, 1998.

Lynda Brazeau, BS, CADC is a Certified Alcohol and Drug Counselor. She provides individual counseling sessions and is a Case Manager. She has a bachelor’s degree in Social Work from Lewis-Clark State College 1998.

Bryan Gimmeson, LCPC married to Theresa Graber-Gimmeson, is a Liscensed Clinical Professional Counselor. He works part-time and provides mental health and group facilitation services. HE has a Master’s Degree in Counseling and Human Services from University of Idaho, 2007.

Theresa Graber-Gimmeson, LPC is a Licensed Professional Counselor. She has a Master’s Degree in Professional Counseling from Grand Canyon University, 2011.

Crystal Nystrom, LCPC, LMHC is our Clinical Supervisor. She is a Licensed Clinical Professional Counselor, Licensed Mental Health Counselor (Washington State), National Board-Certified Counselor. She received a Master’s Degree in Counseling from Liberty University, 2007.

Joel Ruhle, LCSW is a Licensed Clinical Social Worker. He works part-time and provides group facilitation services. He has a master’s degree in Social Work from Boise State University, 2013.

CONSULTATION & SUPERVISION: In order to provide the best services possible, staff may choose to consult with other professionals at ChangePoint or contracted with ChangePoint. Monthly clinical supervision sessions may include live observation or audio/video recording. Colleagues who consult or supervise are subject to the same confidentiality codes.

FINANCIAL RESPONSIBILITIES: Your counseling is focused on your emotional needs, nor financial situation. Payment can be arranged through a variety of payment sources. You will be required to sign a payment agreement upon admission and agree to keep our account paid. If you fail to comply with the agreement services may be suspended until payment is received.  Individual counseling sessions are generally 50 minutes.  Group sessions are generally 2-3 hours long, depending on the group. If you are unable to pay for treatment, please talk with staff regarding a sliding fee scale you may be eligible for.

ETHICAL STANDARDS: ChangePoint staff adhere to the American Counseling Associations Code of Ethics.

REFERRALS AND TERMINATION: If you require additional services that are beyond services ChangePoint offers, and appropriate referral will be given to you. You have the right to discontinue treatment at any time without cause. Your participation and completion of any programs or recommendations are essential to the success of your treatment or recovery. IF you discontinue services against staff advice there may be consequences to you that ChangePoint cannot control.

RECORDS MAINTENANCE: ChangePoint will maintain your records for a period of 7 (seven) years and are the property of ChangePoint. Records are not released outside the agency without written permission by you, with the exceptions outlined above in the confidentiality section. Direct a written request to the Clinical Director to review your records.

APPOINTMENTS: Your appointment time has been reserved especially for you. Although we understand unavoidable situations occur, we do require a 24-hour cancellation notice if possible. Repeated missed appointments may result in discharge from the program. Sessions are generally 45-50 minutes in length. If you arrive more than 15 minutes late for an appointment your counselor may choose to reschedule the session. Office Hours are: 10:00 AM to 6:00 PM Monday through Thursday.

EMERGENCY SITUATIONS: ChangePoint staff attempt to return phone calls within 24 hours except over the weekends or on holidays. If you have an emergency or need immediate assistance, please do not wait for a return call. We recommend that you call 911 or the Suicide Prevention Lifeline 1-800-273-8255.

BOARD INFORMATION:

IBADCC

5607 Cedar Lake Road

Minneapolis MN 55416

(952) 377-8806

Idaho Bureau of Occupational Licenses

PO Box 83720

Boise ID 83720

(208)334-3233