@TraumaTherapySD

@TransAffirm

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    Policies & Procedures

    The following is a detailed explanation of the policies and procedures of my practice. Please review carefully and fully. I am happy to answer any questions you might have.

    BOUNDARIES

    Your relationship with me is a professional and therapeutic one, and therefore there are limitations placed on our interactions. In order to preserve this alliance, it is important that we do not have any other type of relationship(s) as personal and/or business relationships undermine the effectiveness of the therapeutic relationship. I care about helping you, but it would be inappropriate for me to be your friend or have a social relationship with you.  It is generally considered inappropriate for us to exchange gifts. In order to protect your privacy should we run into each other out and about in the world, I will not acknowledge you unless you acknowledge me first. Any conversation should be kept brief and should not be related to our work together or your treatment.    

    MEETINGS

    Normally the first few therapy sessions are an evaluation period. I do a thorough assessment of your needs and your history so that we can develop a strong treatment plan to guide our work together. In general, I will schedule one therapy session per week, at a regular day and time we agree on. Once an appointment time is scheduled, you will be expected to pay for that time unless you provide at least 24 hours advance notice of cancellation (insurance permitting). Multiple or recurrent no shows or late cancellations may result in termination of services, see the section titled Endings for more details.

    Once we get to reprocessing your traumatic memories with EMDR, then longer, more intensive therapy sessions of 90 or 120 minutes are often significantly more efficient and effective. Each session necessarily involves catching up on daily stressors, thus longer sessions allow for substantially more time for focused work toward resolving the primary issues that brought you into therapy. Much more can be accomplished in a shorter period of time through this approach. This is my recommendation, although I recognize there may be limiting factors and we can discuss those and how to proceed as the need arises.

    Due to the nature of my work, there are times when unforeseen clinical crises or emergencies may arise with other clients, requiring that your appointment be canceled or delayed. If/when such situations are unavoidable, I will make every effort to inform you at the earliest possible time and reschedule the missed session time in order to minimize the inconvenience to you.

    I understand that you may use drugs and/or alcohol (including marijuana or prescription drugs), however, therapy is most effective if you come to your appointments sober. Use of drugs and/or alcohol is likely to negatively impact the results of any EMDR reprocessing that we do, so we need to discuss this and develop a plan of approach. If I have concerns that you are under the influence, I will have a discussion with you about whether or not it is appropriate to have our session that day. If you are visibly under the influence or if I have concerns that you are under the influence, and have plans to drive away from session, I will consider you a danger to yourself and will act accordingly.

    If we are meeting in person in the office and you are feeling unwell or under the weather, the expectation is that you will notify me as soon as possible and we will switch to meeting via telehealth, or cancel the appointment if you prefer. If you arrive to session under the weather, I reserve the right to whether or not we will meet.

    CONTACTING ME

    When you need to contact me for any reason, these are the most effective ways to get in touch in a reasonable amount of time:

    By phone (858-276-8831) you may leave messages on the voicemail, which is confidential.

    By SMS text message to 858-276-8831 or secure text message via iPlum.

    By email ([email protected]) traditional or encrypted email available.

    By fax (858-215-5459) which is secure.

    Please refrain from making contact with me using social media messaging systems such as Facebook Messenger or Instagram. It is important that we be able to communicate and also keep the confidential space that is vital to therapy. Please speak with me about any concerns you have regarding my preferred communication methods.

    I subscribe to the following service(s) that can allow us to communicate more privately through the use of encryption and other privacy technologies. None of them will cost you money, but each requires some setup before they can be used. Please ask if you would like to use any of these services:

    Encrypted email by responding to an encrypted email from [email protected]

    Secure text messaging through downloading the free app iPlum at my invitation

    Secure online video chat software by Doxy.me or Zoom

    If you need to send a file or other digital document, please send it via secure email or by fax

    If you wish to communicate with me by normal email or text message, please inform me and I will provide you with a Request for Non-Secure Communications form for you to read and sign off on. 

    MY AVAILABILITY & RESPONSE TIME

    I am not immediately available by phone or text message.  During my work week, Monday through Thursday (9 am to 7 pm), you can typically expect a response the same day for voicemails and text messages. Friday through Sunday and during holidays I may not respond until the following week. I may occasionally reply more quickly than that, but please be aware that this will not always be possible. If you are difficult to reach, please give me some times when you will be available. 

    If you need to contact me about an emergency, the best method is by text/secure message (via iPlum, 858-276-8831), simply let me know it is urgent and I will return your message as soon as possible, it could take several hours. Please do not email me with urgent or emergency situations as I do not check email as frequently.

    Please note that SMS (normal smart phone text messages) are not designed for emergency. SMS text messages occasionally get delayed and on rare occasions may be lost. So, please refrain from using SMS as your sole method of communicating with me in emergencies.

    If you are unable to reach me and feel that you cannot wait for me to return your call, please reach out to someone you know and trust, contact the San Diego Crisis Line at 1-888-724-7240, or go to the nearest emergency room.    

    ELECTRONIC COMMUNICATION

    Be aware that any emails and/or text messages received from you and any responses sent by me may become part of your therapy record.      

    I do not communicate with, or initiate contact with, any of my past or present clients through my personal social media platforms such as Facebook, Instagram, or Linked In. If I discover that I have accidentally established a personal online relationship with you, I will end that relationship and discuss it with you at our next session.  This is because these types of casual social contacts can create significant security risks for you and inadvertently violate your privacy.

    If you choose to follow one of my professional social media pages, please be mindful of the lack of privacy and confidentiality of anything you post, and do not attempt to engage in a clinical or administrative conversation with me on these sites. If you do so, I will not respond until we meet in person, and I will delete your post.

    Please know that if we use electronic communications methods, such as email, texting, online video, and possibly others, there are various technicians and administrators who maintain these services and may have access to the content of those communications. Of special consideration are work email addresses. If you use your work email to communicate with me, your employer may access our email communications. There may be similar issues involved in school email or other email accounts associated with organizations that you are affiliated with.

    Additionally, people with access to your computer, mobile phone, and/or other devices may also have access to your email and/or text messages. Please take a moment to contemplate the risks involved if any of these persons were to access any communications, we might exchange with each other. Proceed accordingly.

    CONFIDENTIALITY 

    In general, the privacy of communications between a client and their psychologist are protected by law, and I can only release information about our work to others with your written permission.  But there are exceptions, and these are listed below.

    There are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about you or your treatment.  These situations include:

    • If I have reasonable suspicion that a child, disabled or elderly person has been or is being abused, I may be required to make a report to the appropriate authorities. 
    • I am required to report if someone knowingly viewed, downloaded, streamed, or accessed child pornography (which includes films, photographs, videotapes, etc.).   
    • If I believe that you are threatening serious bodily harm to someone, I am required to take protective actions.  This may include notifying the potential victim, contacting the police, or seeking hospitalization for you.
    • If you threaten to harm yourself, I may be obligated to take protective action. This may include hospitalization for you or contacting those designated by you who can help provide safety/ protection.  If such a situation occurs in the course of our work together, I will attempt to fully discuss it with you before taking any action.

    If you file an insurance claim to be reimbursed for some portion of the cost of therapy, this gives the insurance carrier the right to inquire regarding some of your information such as diagnosis, dates of treatment and treatment plans. I may disclose medical information to a provider of health care, health care service plan, or contractor for the purposes of diagnosis, treatment, or payment.

    In most legal proceedings, you have the right to prevent me from providing any information about your treatment. However, if you bring up your mental health in a court preceding you waive this right.    In some legal proceedings, a judge may order my testimony if they determine that the issues demand it, and I must comply with that court order.

    In the case of another health epidemic in which cases are being tracked by the government, I may legally required to notify local health authorities that you have been in the office. If I have to report this, I will only provide the minimum information necessary for their data collection and will not go into any details about the reason(s) for our visits.

    I routinely meet with other professionals to obtain consultation and may discuss your treatment and our work together. During such consultation, I do not provide the name or identifying information about the person discussed. The consultants are also legally bound to keep the information presented confidential.  Ordinarily, I will not tell you about these consultations unless I believe that it is important to our work together.

    On occasion I may need to disclose information to employees or agents of my practice for operational purposes. In these cases, those individuals/agents will be bound through an agreement with this therapist to ensure your information remains protected and confidential.

    In the event of my death or incapacity, I have an agreement with a group of colleagues to take possession of my files, and then it would be their responsibility to facilitate you finding another therapist, and giving you access to your records if needed.  

    Although this written summary of exceptions to confidentiality is intended to inform you about potential issues that could arise, it is important that we discuss any questions or concerns that you may have.  I will be happy to discuss these issues and provide clarification when possible.  If you need specific clarification or advice that I am unable to provide, formal legal advice may be needed, as the laws governing confidentiality are quite complex and I am not an attorney.

    AUDIO AND VIDEO RECORDINGS

    I am continuously seeking to improve my skills and seek certifications/consultations to do so, and therefore there may be times when I request to videotape a session. It is always your right to say no, and whatever answer you give will not impact your ability to obtain treatment. No recording (video or audio) of any part of our sessions will occur unless you and I mutually agree, in writing, beforehand that the session may be recorded.

    ENDINGS

    There are a number of circumstances under which therapy can or should end. You may end therapy at any time, but a minimum of a final phone call or session is requested for us to wrap things up.

    If and when services are ended, I will maintain your records for the period of time required by law and will make them available to you or a subsequent therapist upon written request.

    If therapy is ended for any of the following reasons, I will be happy to provide you with referrals to other appropriate treatment professionals should you desire it.

    If you and I both agree that you have achieved your treatment goals, this is something to celebrate and be proud of. In this case we will discuss and review your progress and our work together and then we will end therapy. In this case, you are always welcome to contact me if you would like return to therapy.   

    I am ethically obligated to end therapy if I believe you are not benefitting from this service. Prior to such a decision we can discuss any possible adjustments to our work that might produce change and help you begin to progress. If finding another therapist might be a better option for you this will be discussed as well.

    If you have repeated cancellations and/or no shows to your appointments, we may need to end therapy. My goal will be to try to problem solve ways for us to continue our work together, however, if this behavior continues then I may end therapy with you. If I do not hear from you for 30 days or longer, without prior arrangement, I will consider the therapy ended.  

    If you are unhappy with your treatment or your progress, I hope to create an environment in which you will be comfortable telling me this, so that we can address your concerns and possibly improve the treatment and our relationship. If that does not work or you are not interested, then we will end the therapy.

    Other reasons for possible termination of services include: amassing a substantial unpaid account balance, refusing to comply with treatment recommendations, if I feel that your issues are outside my scope of expertise, repeated boundary violations, or if I fear for my safety. If I have any of these concerns, I will make every attempt to discuss them with you prior to making a decision to end therapy and, as appropriate, you will be given a reasonable opportunity to make the needed changes. 

    BILLING AND PAYMENTS

    My hourly fee is $185.  If we meet more than that time, I will pro-rate accordingly.  If you will be 15 minutes or more late for your session, you must let me know and it will be up to my discretion if we will meet. If I have not heard from you and you are 15 minutes late, I will consider the appointment cancelled and charge for the missed session. You will be expected to pay for each session at the time it is held, unless we agree otherwise in advance. I will request you sign an authorization that I will keep on file allowing me to bill a credit card for such instances. In circumstances of unusual financial hardship, I may be willing to negotiate a temporary fee adjustment or payment installment plan. Invoices for payment(s) are available at your request. An additional $10.00 per week will be charged for session fees not paid on the date of service, which will begin to accrue on the day directly following the date of service. Fees may be paid via cash, check, or credit card. There is a $25.00 fee for returned checks.

    I reserve the right to review and potentially raise my fees once a year. If I choose to increase my fees you will be given a 60-day notice of the increase.  

    In addition to weekly appointments, I charge this same hourly rate ($185/hr.) for other professional services you may need, though I will prorate (in 15 min increments) the hourly cost if I work for periods of less than one hour.  Other professional services include but are not limited to report writing, telephone conversations lasting longer than 10 minutes, attendance at meetings with other professionals you have authorized, or preparation of treatment summaries.  If you become involved in legal proceedings that require my participation, you will be expected to pay for any professional time I spend on your legal matter, even if the request comes from another party. I charge a copying fee of $0.05 per page for records requests. This fee will be waived if you choose to have your records sent by encrypted email or fax.

    If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment.  This may involve hiring a collection agency or going through small claims court.  If such legal action is necessary, its costs will be included in the claim. In collection situations, the only information I will release regarding a client’s treatment is their name, the dates/times/nature of services provided, and the amount due.    

    INSURANCE REIMBURSEMENT

    In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. 

    If you have an insurance plan for which I am a covered provider (Medi-Cal), then I will submit claims for you. By signing this agreement, you are authorizing me to release any information necessary (including notes, treatment plans and diagnosis) to your insurance plan to process claims, determine medical necessity, or to request additional sessions. By signing this agreement, you are also authorizing your insurance plan to pay benefits directly to me.

    If you have a health insurance plan for which I am not a paneled provider I will be considered an ‘out of network provider.’ Some insurance plans cover a portion of mental health treatment in these situations.   If requested I will supply you with a superbill (which is like a receipt) to submit to your insurance company for possible reimbursement for the therapy fees. Regardless, payment is due at the time of service and you are responsible for that payment.

    If you would like to seek reimbursement through your Health Savings Account (HAS) or a Health Reimbursement (HRA) this would be a similar process in which I can provide you with a superbill and it is your responsibility to seek reimbursement from these accounts for this service.  In either case you (not your insurance company) are responsible for full payment of my fees. If you have a Flexible Spending Account (FSA) debit card, you can also choose to pay for my services that way and it will be processed just like any other credit card payment. 

    Telehealth

    “Telehealth” includes the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, video, or data communications. Telehealth also involves the communication of my medical/mental information, both orally and visually, to your health care practitioner located in California.

    Your Rights

    You have the right to receive services via telehealth or via an in-person visit.

    The use of telehealth services is voluntary, and your consent to using this service can be withdrawn at any time. Withdrawing your consent to meet via telehealth will not affect your ability to access covered services in the future.

    If you are using Medi-Cal insurance, there may be coverage available for transportation to in-person services, when other available resources have reasonably been exhausted.

    Risks and Benefits

    As with traditional psychotherapy, telehealth has both benefits and risks.  Because of the technology involved in telehealth, there are more risks to confidentiality than simply sitting in a traditional therapy office. Dr. Lord has adopted a HIPAA compliant platform for providing telehealth services to protect your privacy and be in compliance with various legal and ethical guidelines.

    Risks: A potential risk of receiving telehealth services include delays in mental health services due to technological equipment failure, a lack of access to all relevant information, or a security breach. There is the possibility, despite reasonable efforts on the part of your psychotherapist, that: the transmission of your medical information could be disrupted or distorted by technical failures; the transmission of your medical information could be interrupted by unauthorized persons; and/or the electronic storage of your medical information could be accessed by unauthorized persons.

    An important part of therapy is sitting face to face with an individual, where non-verbal communication is readily available to both therapist and client. Without this information, telehealth may be slower to progress or less effective. What is important here is that you are aware that telehealth may or may not be as effective as in-person therapy and therefore telehealth services will be used only as an adjunct to our usual, face to face work together.

    Benefits: In addition to the added risks of telehealth, there are added benefits as well. Telehealth provides a way for us to remain connected and continue the work together, even when we cannot meet face to face. Continuing to do the work in these circumstances is more beneficial than taking a break from therapy.

    You are being offered the option of telehealth services as I have determined that this is an appropriate option for you, our therapy, and the stage of work we are at. The appropriateness of telehealth services will be something that is being continually evaluated by your psychotherapist and if at some point Dr. Lord determines it is no longer appropriate we will discuss our other options and/or discontinue telehealth.

    Policies & Procedures

    With telehealth, there is the question of where the therapy is occurring – at this time, the therapy is considered to be occurring in whatever location the client is at and the laws, rules and regulations of that state are the ones that apply to the telehealth services.  Therefore, the decision to use of telehealth will be made ahead of time as I will need time to determine if I can legally and ethically provide services to you in whatever state you are currently located. Only if you are still in California could telehealth be considered as an ad hoc service.

    Privacy Considerations

    In order to get the most out of your telehealth services, there are steps that you will need to take.

    • Choose a private location to place your telehealth call.
    • In order to provide the best call environment, you should reduce background light from windows or light emanating from behind you.
    • Your camera should be placed on a secure, stable platform to avoid wobbling and shaking during the telehealth session. To the extent possible, your camera should be placed at the same elevation as your eyes with your face clearly visible to the other person.
    • The presence of any third party must be disclosed and agreed to by both you and your psychotherapist. Your psychotherapist reserves the right to end the telehealth session at  any time in order to protect your privacy and your health information.

    Technology failures

    In the event that the video platform technology or internet services fail and we are unable to continue the telehealth session:

    Colette Lord, PhD., will place a phone call to your cell phone in order to determine what the next best steps are.

    If we are unable to connect via phone, I will send an email to check in with you.

    If there are any safety concerns and we are unable to reconnect within the hour, I may determine a welfare check is needed to ensure your safety and/or the safety of others.

    If you are feeling unsafe and we are unable to reconnect, you should take steps to get help locally.

    Emergency Procedures

    It is part of your responsibility to familiarize yourself with the resources in the physical location that you will be in. Your therapist will also familiarize herself with those resources so that you can be directed to any needed resource.

    Billing

    You are responsible for the cost of this service in the same manner you are responsible for the cost of traditional face to face services. Payment is due at the time of the service.

    Therapy Dog

    This practice has a therapy dog (currently in training) who is present in the office for sessions on a daily basis. This document covers some of the benefits and risks to working with a therapy dog, as well as a list of rules for interacting.

    Benefits

    Research shows the power of animals to calm the nervous system and provide powerful grounding, comfort, and much-needed comic relief during the challenging work of therapy.

     

    Risks

    • While I am being trained to observe body language and facilitate a safe interaction, dogs by their nature can be unpredictable, therefore, there is always a possibility that someone will get scratched or bitten or injured.
    • While the therapy dog is a puppy, there is as an additional layer of unpredictability as they learn their role. Puppyhood comes with extra dose exuberance as well. You will be taught the verbal and hand signals needed to give the dog the direction they need.  This will be a learning process for all involved, so your patience is appreciated.
    • While the therapy dog has been screened by a veterinarian before beginning work in my practice, and will get routine evaluation and screening, animals can carry disease. Because your contact with the dog is minimal, the risk is very small. The therapy dog is up to date on all vaccinations and will remain so.
    • There is the risk of allergic reaction to the dog hair/dander.

    Rules

    • Becoming aggressive (hitting, kicking, bites, pulls, pinches, etc.) toward the therapy dog will be considered grounds for termination of therapy.
    • It is important for the therapy dog to always be treated gently.
    •  If you have allergies to dogs, this therapy practice may not be a good fit for you as my therapy dog is an integral part of my practice and will be present in the office daily. If you suffer from allergies it is your responsibility to inform me if you are having issues so that we can minimize those issues.
    • If you have a fear of dogs, please inform me ahead of time so that we can determine if this practice will be a good fit and how to minimize any fear reactions upon meeting the therapy dog.
    • If I determine that the therapy dog is tired and/or appears to not be up to engaging in the session, then I will allow them to not participate in session. Care for my dog’s well-being is important and her limits and preferences will be respected.
    • It is understood that the therapy dog will determine their level of interaction with others on any given day. The therapy dog will never be forced to interact if they demonstrate resistance, just as I will not force you to interact with them if you have no interest or demonstrate resistance.
    • You have the right to decline to interact with my therapy dog and they will be confined to their kennel for the session. It is your responsibility to let me know if you do not want to interact with the therapy dog in any given session.
    • If you have a service dog or emotional support dog that you wish to bring with you to session, we will need to discuss this ahead of time so that we can determine the best way to introduce our animals and minimize any possible disruptions to the therapy session.

    You will be asked to sign off on the following:

    • Understand and agree to abide by the rules of interacting with the therapy dog.
    • Have been provided the risks associated with the presence of a therapy dog.
    • Consent to engaging in therapeutic services with a therapy dog present.
    • Accept full liability in the event that the therapy dog causes any injury to you or your property during the course of treatment.
    • Are not aware of any fear, allergy, skin or respiratory sensitivity, or other medical condition that would render interaction with, or proximity to, a therapy dog, harmful to your health.