Treatment Policies Form

TREATMENT POLICIES AND AGREEMENT

Revised September 2017

Welcome to Center for Developing Kids. Our mission is to provide children with the opportunity to attain their highest developmental potential using a collaborative and caring, multi-disciplinary team approach. We strive to provide quality therapy services, which do not separate the child from the context of his/her family or typical everyday environments; and ultimately enable the child to engage in activities that give meaning to his/her life. In order to serve you and your child effectively and to eliminate misunderstandings, please carefully read the Treatment Policies and Agreement below and sign at the bottom of the page.

WHAT TO EXPECT AT THE FIRST THERAPY APPOINTMENT

  1. If possible you will be given a tour of the clinic and be introduced to the front-office staff and owners if you have not been here before.

  2. This document will be carefully reviewed.

  3. The first appointment is critical to the intervention process as it will directly impact your child's progress. We spend this time understanding the primary needs and concerns for your child and family. The therapist will most likely review this document in an enclosed room and your child can play quietly while you are meeting. The first appointment also provides the therapist time to observe and interact with your child informally in order to build rapport and begin treatment planning. Our goal is to increase your child's independence and successful engagement at home, in school and/or in the community so that they no longer need specialized services.

WHAT WE EXPECT FROM YOU

We expect that your therapist will respect and seriously regard your needs and opinions and we expect that you will respect and seriously regard your therapist's opinions as each of you have the best interest of your child at heart. We expect that you will communicate your needs in ongoing dialogue to your therapist and will consistently make appointments. We expect you to know and follow this Treatment Policies and Agreement and let us know if you have concerns about your collaborative relationship with Center for Developing Kids.

CANCELLATIONS, MAKE-UPS, & TERMINATION OF THERAPY SERVICES

It is extremely important that you do not cancel unless absolutely necessary and it is imperative that you arrive on time. If repeated late arrivals occur (15 minutes or more to 25% of sessions over a three-month period) your child's therapy may be terminated. You must call to cancel a minimum of 24 hours prior to your scheduled appointment. The best progress for your child will be seen with consistent intervention. The therapists make considerable effort to prepare for each sessions and cancellations are a hardship. If your therapist is sick and another therapist is not available to see your child, you will receive a call or email.

If you do not cancel within 24 hours of your scheduled appointment or do not show up ("no show") for your scheduled appointment YOU WILL BE BILLED A LATE CANCELLATION FEE OF $40. If your child become ill on the day of a scheduled appointment please call or email to cancel as soon as it is clear your child will be unable to attend in order to avoid the $40 charge. If you cancel on a frequent basis (25% or more missed appointments over a three month period) your child's therapy will be terminated.

Each funding agency has very specific rules regarding make ups. School districts allow make ups within 30 days. Regional Centers allow for make-ups within the calendar month and private pay or insurance appointments can be made up any time. Although every effort to schedule make ups will be made it is not always possible. Priority for make-up sessions are given to those families that consistently keep their regularly scheduled appointments.

THERAPY SESSIONS

Sessions are provided either individually or in a group depending on what is mutually agreed upon as the best type of intervention for your child. If your child is receiving therapy in the home or community, a caregiver must be present at all times. For children receiving clinic based therapy parents usually remain in the waiting room but parents are always welcome inside the clinic as long as they are directly interacting with, and remain close to the therapist and their child at all times. Observing from afar, talking or texting on cell phones, reading, working on personal business, or using a computer is not permitted within the clinic.

Children with certain diagnoses or clinical conditions may require the parent in the clinic regularly as determined by the therapist. Liability prevents anyone, including parents and siblings, from being in or using the treatment area without a therapist or using toys or equipment from the clinic in the waiting room.

RE-EVALUATION

An annual re-evaluation will be conducted each year for private pay clients. When the evaluation is completed during your child’s regularly scheduled therapy appointment(s), only a re-evaluation report charge will be billed. If your child is school funded, evaluations are conducted when an assessment plan is signed. If your child is funded through insurance, a re-evaluation will be conducted per the insurance company’s guidelines.

SCHEDULING

Scheduling is based on the availability of the therapist, the days and times requested and the availability of appropriate treatment space. Requested schedule changes will be accommodated if possible but cannot be assured. At times, your therapist will take time off to attend a meeting on behalf of a child, for continuing education, vacation, or sick time. Center for Developing will provide coverage whenever possible for your child’s therapy session either on another day with your therapist, or on the same day with another therapist. It has been our experience that periodically having another therapist cover the session is beneficial to the child, parent and therapist as it provides increased opportunities for professional collaboration.

INTERNSHIP PROGRAM

Center for Developing Kids collaborates with accredited universities throughout the country by accepting occupational, physical, and speech therapy interns as part of a fieldwork/intern program. Most interns have completed all or most of their academic requirements for an advanced degree (Masters or Doctorate). When your child’s therapist is a clinical instructor, it is likely that an intern will participate in all aspects of your child’s treatment. The interns’ experience lasts up to 16 weeks and they are closely supervised by their clinical instructor. This fieldwork/intern program allows Center for Developing Kids to reinforce our commitment to promoting excellence in clinical practice to maintain the high standards of our professions.

PARKING

It is the building management’s policy to charge for parking. Center for Developing Kids does not validate. There is free two hour street parking on surrounding streets.

ARRIVAL

It is imperative that you arrive on time. If repeated late arrivals occur (15 minutes or more 25% of sessions) your child’s therapy may be terminated. When you arrive, please sign in and use the intercom to announce your arrival following the posted directions by the telephone. You will not hear a response on the telephone. If your child’s therapist does not pick up your child within a few minutes of your appointment time, please page again through the intercom or let the office staff know you are here since occasionally the page is not heard. You may not drop off your child unattended. If you will not be observing your child’s treatment or remaining in the waiting room, you must leave a phone number where you can be reached in case of an emergency. If your child is being treated in the community (such as at a park) or in the home a caregiver must be present throughout the session.

You are responsible to fully supervise your child and any siblings, if any, at all times in the waiting room and in the courtyard. Please pick up toys and books after your child and prevent them from standing on chairs and tables. Food and drink are not allowed in the waiting room but there are benches, a table and chairs just outside the waiting room that you can use.

Children are not permitted to climb on the courtyard planters or poles and the building does not allow “ride-on” toys in the courtyard. For safety reasons and out of respect for the other businesses in the building, please do not allow your child to run through the courtyard or to use excessive noise. If your child needs a diaper change please take them into the restroom. Please supervise your child at all times in the restroom.

DEPARTURE

Following therapy your child will be brought to the waiting room by the therapist who will assist your child in transitioning, provide a brief report on the treatment that just occurred and answer questions. If you or your child’s therapist have questions that require more than a few minutes of discussion, the treatment session should be ended earlier than usual to allow for this time. It is imperative that your child be picked up on time and you MUST be in the waiting area when your child and therapist come out of the clinic. If not, you will be charged $1 per minute for each minute you are late. If we need to charge you more than once you will be asked to remain in the waiting area during your child’s therapy.

CHARGES (Sometimes covered by funding agencies)

Therapy: Occupational, Physical or Speech $130/hour
  Feeding Follow Up Intervention $130/hour
Assessment: Occupational, Physical or Speech Therapy $550
  Sensory Integration and Praxis Tests (SIPT) $975
  Team Feeding $575
Meetings: IEP’s, family meetings, mediation, community inservice $130/hour
Reports: Annual re-assessment, Progress, Equipment $130/per report
Programs: Kids Connection (small group social emphasis) $88.35/session
  Write On (handwriting clinic one week in summer) Check website
  SUNKIDS summer program (three weeks in summer) Check website
Late Pick Up:   $1/minute
No Show or Late Cancellation:   $40

BILLING

Insurance
Your insurance card must be presented and services authorized prior to receiving an evaluation and/or treatment. A credit card MUST be left on file to pay for deductibles, late cancellation fees and/or co-payments. An explanation of charges will accompany your payment receipt and invoice. It is your responsibility to notify us if there are changes to your insurance. It is recommended that you check with your insurance company to ensure that the services you are requesting are a covered benefit per your specific policy. In the event that your insurance company does not pay within 45 days for sessions already completed, you are responsible to pay for such sessions at the contracted reimbursement rate. If your insurance benefits become exhausted or efforts to extend said benefits are denied, but you would like to continue services, you are responsible to pay for any sessions provided at the above therapy rate (see charges). If your child is concurrently receiving insurance funded therapy at another facility, it is your responsibility to inform the front office immediately to avoid an overage in allowed benefits. You are welcome to pay privately while awaiting authorization of services but please be aware there will be no reimbursement for past services provided that were paid privately.

Private Pay
You are expected to pay for services at the time rendered. A credit card MUST be left on file to pay for late cancellation fees. An explanation of charges will accompany the payment receipt and invoice.

Regional Center
If your child is funded through Regional Center, a current authorization MUST be in place prior to your child being initially evaluated and/or treated. A credit card MUST be left on file to pay for late cancellation fees.

School District
If your child is funded by a school district, we require a signed master contract, a signed Individual Service Agreement (ISA) and a signed copy of the Individualized Educational Program (IEP) prior to implementing services. These documents are typically provided by the school district, however, we may ask you for a copy of the IEP to expedite therapy services. When an IEP enters into “stay put” Center for Developing Kids reserves the right to place a time limit on the continued provision of support services. In this event, Center for Developing Kids shall promptly notify the district and shall continue services for a period not to exceed ninety days (90) to allow the district sufficient time to secure an alternate Non Public Agency (NPA) to provide therapy services.

School districts fund therapy services only when school is in session and your child has attended school that day. They will not fund during school vacations or holidays unless otherwise indicated on the IEP. Occasionally, with written permission from the school district, compensatory sessions are provided. You may pay privately at the time service is rendered during school vacations or holidays. If you do not let your therapist know at least two weeks in advance that you would like to attend therapy during these times they will assume the sessions are canceled. A credit card MUST be left on file to pay for late cancellation fees.

VACATIONS AND EXTENDED ABSENCES

Notification of vacations or extended absences in which two or more consecutive treatment sessions will be missed, should be made at least two weeks in advance. Extended absences from scheduled appointments can occur for a variety of reasons that include, but are not limited to: Hospitalizations, Vacations, Therapeutic Programs, Community Programs.

IN CASE OF AN EMERGENCY EVENT

Following an emergency event, assuming conditions are safe, children will be released to their parent or guardians. If it is not feasible for a parent or guardian to pick up a child, employees will take children to a verified safe location determined by the American Red Cross and/or communicated by the National Emergency Broadcast System. This location will be posted visibly at the clinic site. In an immediate building evacuation, employees and children will be instructed to assemble in the south end of Houston’s parking lot (corner of Del Mar Blvd. and Arroyo Parkway).

CONDITIONS OF TREATMENT

  1. CONSENT TO TREATMENT
    I hereby consent to the administration and performance of all diagnostic procedures and treatments within the realm of current standards of practice, which in the judgment of my child's therapist may be considered necessary or advisable.

  2. DISCRIMINATION
    Center for Developing Kids does not discriminate on the basis of race, religion, sex, national origin, sexual orientation, age, or disability.

  3. RELEASE OF INFORMATION
    I hereby agree that Center for Developing Kids may release information, either written or verbal, regarding my child’s medical status and progress to professionals who have been or are currently involved in the treatment of my child. I hereby agree that, to the extent necessary to determine eligibility for services and to obtain reimbursement, Center for Developing Kids may disclose portions of my child's records to funding agencies such as health care service plans, school districts and Regional Centers. Center for Developing Kids will not be held responsible for use of the information released.

  4. FINANCIAL AGREEMENT
    I hereby agree that in consideration for services to be rendered by Center for Developing Kids, I shall make prompt payments to the account of Center for Developing Kids as bills are presented. I agree to pay interest at the legal rate should the account become delinquent, and if it becomes necessary for the account to be referred to an attorney for collection, I shall pay the actual attorney's fees and collection expenses. I request that payment of authorized insurance company benefits be made to Center for Developing Kids for any services furnished per assignment of benefits provisions of my insurance. I permit a copy of this authorization to be used in place of the original.

  5. CONSENT TO PHOTOGRAPH
    I hereby agree to allow Center for Developing Kids to take and/or use any pictures/tapes/videos/films of me or my child with my full knowledge and consent as a client of Center for Developing Kids. This visual record may be used for teaching and training activities and/or as part of my child’s medical/developmental record as Center for Developing Kids may deem proper. My child’s identity will not be made public without my expressed permission for a specific occasion or purpose. Any use of my child for public relations will also require my specific permission and knowledge.

I HAVE READ AND AGREE TO THE ABOVE STATED POLICIES.


Please sign below.