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New Life Christian Counseling Center, Inc. Brian Campbell, Ph.D. Licensed Psychologist
FL License: PY0004142
This handbook explains the rights and obligations of you, the client, and me, Dr. Brian Campbell. Florida Law imposes some of these rights and obligations; others are established herein by contractual agreement between us. Any concerns regarding the matters stated herein should be discussed with me. Absent a memorandum signed by both of us indicating otherwise, this handbook establishes the terms and conditions pursuant to which services are provided and is binding upon both of us.
All communications between you and me in the course and furtherance of the psychotherapeutic relationship will be treated as strictly confidential. As the client, you control whether or not I may disclose confidential information. You have the power to waive confidentiality. As a matter of office policy, I ask that all waivers of confidentiality, in whole or in part, be on forms provided by me.
There are exceptions to confidentiality mandated or implied by Florida law. Under the following circumstances I will breach confidentiality:
1. When I have cause to suspect that a child has been or may currently be a victim of physical, sexual, or emotional abuse.
2. When I have reasonable cause to believe you pose a risk of imminent harm to yourself.
When I have reasonable cause to
believe you pose a risk of imminent harm to another individual.
4. When I am compelled to testify pursuant to a valid court order. (In this circumstance, I will assert that the communication is privileged and will only testify after you have had an opportunity to obtain a court order protecting the confidential information.)
Clients generally wish to establish certain limited waivers of confidentiality. Unless otherwise specified in writing, you agree to the following limited waivers:
To the referral source.
You agree that I may contact the individual or agency
that referred you and may convey the following limited
information: (a) the fact that you have been seen and evaluated;
(b) the number of sessions you have attended (or missed);
(c) anticipated length of treatment; and
(d) general comments regarding your prognosis, fitness
for employment, and participation in treatment.
2. For medical consultation. You agree that I may consult with your physician(s). You authorize the release of information from your physician to me and vice versa to facilitate such consultation.
3. For consultation with professional peers. From time to time, I may consult with my professional peers regarding a clinical matter. My professional peers are likewise bound by confidentiality. You authorize the release of information reasonably necessary to such consultation. It is understood that your name will not be released to the consulting physician in such cases.
4. Third party payers. You agree that I may release information to the extent necessary to obtain payment from third-party payers (e.g. your insurance carrier).
CHILD AND ADOLESCENT TREATMENT
Both the parents have the right to be informed about their child’s treatment. I will, however, respect the confidences of your child or adolescent when, in my opinion, it is in his/her best interest to do so. Absent such a guarantee of confidentiality, your child or adolescent may not trust me enough to establish a therapeutic relationship and treatment may be less effective.
Where children and adolescents are seen in treatment, it may be desirable to consult with their teachers. You agree that confidentiality is waived to the extent necessary to effect such consultation.
Also, child and adolescent therapy frequently requires the active involvement of significant individuals in a child’s life. If necessary, you agree to participate in your child’s or adolescent’s treatment and agree to assist in getting other significant individuals in the child’s life to participate as well.
QUALIFICATIONS AND TREATMENT ORIENTATION
Dr. Campbell is a licensed psychologist in the state of Florida (PY 0004142). Dr. Campbell has extensive training and experience in a variety of treatment techniques. The main treatment modality utilized by Dr. Campbell is that of Cognitive-Behavioral Therapy (CBT). Implementation of CBT may involve a variety of established secular scientific treatment techniques.
Dr. Campbell is a practicing Christian. As such, Dr. Campbell also specializes in providing CBT from a distinctly Christian perspective. This perspective may involve the utilization of scriptures from the bible, prayer, or other religiously oriented activities. The incorporation of Christian concepts/content together with traditional secular CBT is termed: Christian Cognitive-Behavior Therapy (CCBT). Dr. Campbell will discuss with you at the onset of treatment whether you would prefer counseling based on secular CBT or religiously oriented counseling utilizing CCBT.
FAMILY, GROUP AND COUPLES THERAPY
When multiple individuals are seen in therapy, each of the individuals present has the power to waive confidentiality even though he/she may not have the right to do so. You should be aware that in group counseling, it is not always possible to guarantee confidentiality of information because of the power of the individuals involved in counseling to reveal confidential information, even though they agree not to do so. Of course, the therapist is bound by law to maintain confidentiality.
Unless otherwise specified, when multiple individuals with a common bond or relationship are seen in therapy, the “client” is the relationship that binds the individuals together (e.g., the “marriage” in marriage therapy). Therefore, in order for information to be released to one of the clients involved in the counseling, or to the client’s lawyer, all clients in the “relationship” must give written consent for release of information.
Individual therapy for any of the participants in the relationship is available by referral.
You and I may deem it appropriate to make a referral to another practitioner for specific services. I know many professionals in my field and in related fields and will gladly make any necessary arrangements. My knowledge as to the competence of others to whom I refer comes, in part, from the reports, from other clients, and thus I cannot take personal responsibility for their competence.
I will, from time to time, take time off for vacation, to attend seminars or because I am ill. Psychotherapy is a uniquely personal service and, therefore, therapy may be briefly interrupted. I will attempt to give you adequate advance notice and will arrange coverage for any emergencies by a peer.
Current fee is $125.00 for a 50-60 minute session for individual or family therapy, $155.00 for the initial consultation.
Payment is expected at the time of each visit. If you have insurance, we will, if you wish, verify benefits with your insurance company prior to your appointment. We will accept your portion or copay of the fee at the time of each visit and will bill your insurance for their portion unless your insurance is such that the benefits are reimbursed directly to you. In these cases, we will bill the insurance company for you, but ask that you pay us the full fee at time of service.
As a clinician, what I give to my client is my time. Please try to be on time for your appointment. It is generally impossible, on short notice, to fill a time slot that had been reserved for a client.
We charge a cancellation fee of $125 if you do not give us 24 hours’ notice on canceling an appointment and we have clients waiting to reserve an appointment. We do not “double book” appointments, and when a client does not come to a session we do not have the opportunity to counsel someone in your place unless we have notice to call someone from our waiting list. We hope you understand this policy is necessary to encourage clients to notify us of an absence so that we can accommodate others in need.
I try to be available to my client by telephone for any emergency. In the event that I cannot be reached, crisis assistance can be obtained by calling or going to the emergency room of your local hospital, or by dialing 911. When necessary, due to unusual circumstances, I will try to make myself available for telephone psychotherapy sessions. Such sessions are generally less desirable than face-to-face session and are therefore reserved for unusual circumstances.
Clients may have strong feelings toward their clinician. I would like you to discuss these feelings with me as part of the therapeutic relationship. In the extremely rare circumstance that we have a dispute that cannot be resolved between us, we both agree to submit the dispute to binding arbitration. If an arbitrator and simple arbitration rules cannot be agreed upon by us, we agree in advance to be bound by the rules of the American Arbitration Association and will accept a randomly selected arbitrator from a list of approved arbitrators maintained by the court of this circuit.
Notice of Privacy Practices Summary
The following is a required "Notice of Privacy Practices" (NPP), in keeping with Federal HIPAA requirements.
Overview of Privacy Issues:
The laws regarding privacy of personal health information are complicated. Federal regulations require your approval of a full NPP as part of receiving health services. To accomplish this, I will provide you with a copy of the full, legally required NPP and this shorter version, which summarizes the same information. Finally, there is a standard consent form that documents your agreement with the NPP. I am not permitted to provide treatment without an executed consent form. You also may have additional questions or concerns, including about situations not covered by this information, and you are encouraged to voice these.
The health information in your records will be mainly used to provide treatment, to arrange payment for services, and for some other business activities that are called, in the law, "health care operations." Before private information can be disclosed (sent, shared, or released) for any additional purposes, a separate authorization form is required to allow it.
Your health information is private and will be kept that way, but there are some times when the law requires disclosure. For example:
Your Rights Regarding Your Health Information:
If you have any questions regarding this notice or the health information privacy policies at this office, please contact Dr. Brian Campbell, as the Privacy Officer for the purposes of the above issues. The telephone number and address is on the letterhead of this Handbook.
The effective date of this notice is December, 2013.
Note: In order to receive treatment, you must sign a “Consent for Treatment Form” that acknowledges that you have read are in agreement with the Client Handbook, including the information contained in the NPP form.