welcome packet - behavioral innovations

30
1 Welcome! We would like to welcome you to Behavioral Innovations Treatment Center Services. We are excited that you have chosen BI as your child’s ABA provider. If any questions arise at any time, feel free to bring those to our attention. We are here to help your family in any way possible. Please make sure you complete the enrollment packet prior to your start date. Again, thank you for choosing Behavioral Innovations as a partner for your family. We look forward to our journey together. First day will be on: Schedule will be: Items to bring: ___ Backpack ___ Packed lunch, 1 morning snack, and 1 afternoon snack (label items, for example am snack, lunch and pm snack) ___ Extra set of clothes in the backpack enclosed in a Ziploc bag with initials ___ 3 packages of wet wipes in the backpack with initials (sensitive, non-scented, if applicable) ___ 5-6 Pull-ups/diapers (if applicable) In addition, please bring the attached enrollment packet on or before the first day. Let me know if you have any questions in reference to this packet. Sincerely, Behavioral Innovations Team

Upload: others

Post on 18-Dec-2021

4 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Welcome Packet - Behavioral Innovations

1

Welcome!

We would like to welcome you to Behavioral Innovations Treatment Center Services. We are excited that you have

chosen BI as your child’s ABA provider. If any questions arise at any time, feel free to bring those to our attention.

We are here to help your family in any way possible. Please make sure you complete the enrollment packet prior to

your start date.

Again, thank you for choosing Behavioral Innovations as a partner for your family. We look forward to our journey

together.

First day will be on: Schedule will be: Items to bring:

___ Backpack

___ Packed lunch, 1 morning snack, and 1 afternoon snack (label items, for example am snack,

lunch and pm snack)

___ Extra set of clothes in the backpack enclosed in a Ziploc bag with initials

___ 3 packages of wet wipes in the backpack with initials (sensitive, non-scented, if applicable)

___ 5-6 Pull-ups/diapers (if applicable)

In addition, please bring the attached enrollment packet on or before the first day. Let me know if you have any

questions in reference to this packet.

Sincerely, Behavioral Innovations Team

Page 2: Welcome Packet - Behavioral Innovations

2

Drop Off and Pick Up Procedure

Drop Off: Please contact your local Business Manager with specific questions or requests related to drop off

procedure. If you will be late please call the Treatment Center as soon as possible so that we can notify staff and

make schedule changes if needed. If your child will not be coming for the day due to illness or other reasons, please

call at least 30 minutes prior to the session start time so that we can adjust our schedule accordingly.

Pick Up: Please contact your local Business Manager with specific questions or requests related to pick up

procedure. If you will be late please call the Treatment Center as soon as possible so that we can notify staff and

make schedule changes if needed. Late pick up fees may be applied for the first 15 minutes beyond scheduled pick

up time and each additional minute. Please see the non-covered service waiver for more information.

Lunch Policy

If your child will be at the Treatment Center during lunch or snack times, please send your child with a packed

lunch and two snacks each day. We ask that the lunch and snacks be ready to eat straight from the lunch box. We

will pack up uneaten portions of the lunch and snacks whenever possible to allow you to see how much your child

is eating while at the center.

Inclement Weather Policy

Behavioral Innovations top priority is providing the best service to our clients. Our weather policy will be such that

if the local Independent School District (ISD) is cancelled, then Behavioral Innovations will also be closed. If the

school district opens on a delay, our treatment centers and in-home therapy services will also open at the same

time as the school district. Behavioral Innovations will also determine if a Saturday make-up day is possible for

those students missing the day of therapy.

* We do not follow the school district’s holiday schedule, please see the Behavioral Innovations calendar for holiday closures.

Page 3: Welcome Packet - Behavioral Innovations

3

Treatment Center Service Agreement

______________________________________________________________________________ Client: Date:

Parent(s):

Parent Regulations

This is an agreement between the above listed parent (s) and Behavioral Innovations, also referred to as BI.

1. BCBA’s will develop a treatment plan/plan of care based on the results of the client’s assessment battery. At

that time, parents will be asked to sign the plan of care as a means of consenting to treatment. Consent for

treatment can be revoked at any time by parents. This should be done in writing.

2. Pay a non-refundable enrollment fee to secure placement for new clients (if appropriate).

3. An emergency contact form must be completed and accurately maintained on file at all times.

4. Parents are responsible for immediately notifying BI of any concerns regarding the program, BI staff members,

etc. so that these concerns can be addressed.

5. Parent(s) must participate in the parent-training component of their child’s treatment program, parent goals,

meetings and trainings.

6. Parent(s) is/are responsible for notifying staff and consultant of any dietary restrictions.

Parent(s) is/are responsible for providing labeled snacks and a labeled packed lunch for their child every day.

We also ask parent(s) notify the BCBA of any medications that the child is taking.

7. BCBA’s must be notified of any and all alternative therapies (this does not imply endorsement or prohibition,

but that the info, must be considered when making treatment decisions).

8. Parents are to only observe and discuss their child’s program with Treatment Center staff. Due to our respect

of confidentiality requirements for the children participating in our programs, your child will not be discussed

with other parents, and we will not discuss other children with you.

Page 4: Welcome Packet - Behavioral Innovations

4

9. Sessions can only take place if the child is healthy. In the event of illness (e.g. 99.5 degree or more fever, green

mucus in the nose, nausea, vomiting, and diarrhea), the parent(s) must contact the Center as soon as possible

or the Treatment Center will contact the parents and sessions for that child will not take place and the child

will need to be picked up as soon as possible. The child is to be symptom free for 24-hours before returning to

the center including absence of fever reducing medications.

10. Parents will complete all required paperwork in a timely manner.

11. The Center will be closed for some holidays, Conferences & Training seminars, Staff training/Planning Days.

Please see the BI Calendar for specific dates.

12. Fees must be paid on or before the 10th and 25th of every month. Your invoice will be sent on the 1st and 15th of

every month. A $25.00 late fee will be assessed after you are 30 days late. Services can be put on hold if you are

30 days or more if your financial account is delinquent. If you are utilizing our automatic payment system, you

will be charged on the designated credit card on the 10th and/or 25th of each month for all charges due. BI

accepts the following forms of payment: credit card, check, cashier’s check and money order. Cash is not

accepted.

13. It is your responsibility to notify us of any insurance changes. If an agency provides funding for your child’s

services, BI will make payment arrangements and agreements with that particular agency. However, if the

agency discontinues funding, you will be notified and given the opportunity to secure different funding or

discontinue services.

14. Private fees will be charged by the service/session on an hourly basis. The plan of treatment typically includes

therapy, parent meetings, planning, and supervision. These services will be charged individually. The parent

meetings, planning and supervision are not optional as these services are necessary to your child’s success in

therapy.

15. Absences, late arrivals & early departures will be tracked closely. If there is a pattern, we will set a more

realistic schedule for your child. We are requiring that you notify us in advance of planned absences, late

arrivals or early dismissals so that we are able to adjust staff schedules or serve a client on our growing waiting

list. If we receive less than a 24-hour notice, we will not be able to adjust accordingly. Last, if consecutive

sessions are missed and the family has not communicated with BI, this will be considered treatment

abandonment.

Page 5: Welcome Packet - Behavioral Innovations

5

16. We are happy to attend your child’s ARD meeting to provide treatment information. If you would like for us to

attend, please understand not all insurance companies cover this service. If it is not covered, you will be billed

$125/hour for the BCBA’s time and mileage at the federal reimbursement rate.

17. It is our goal to provide your child the number of hours agreed upon and reflected by your child’s treatment

plan. However, if we are unable to complete or make up the session once due to our cancellation, you will not

be charged for the cancelled session. If a BI employee cancels a session, that session will be made up as soon as

possible. Please see cancellation policy in the handbook.

18. This contract can be discontinued by the parents by giving a minimum of one month’s written notice. If the

parents discontinue this contract without giving one month’s written notice, a fee equal to one month’s tuition

will be assessed. If the parents discontinue services with Behavioral Innovations in the middle of the one

month’s written notice, you will be charged a “service fee” of $25.00 per day/session that your child would

have been present. If BI has a contract with an agency to provide services for your child, the types of notice

parents need to provide BI will be dependent on that contract. Please note that the summer semester tends to

be a busy time of the year, therefore we start a waiting list for families that wish to change their enrollment

status as early as a year prior.

19. BI operates on 3 semesters per year (Spring: Jan-May, Summer: June-August, Fall: Aug-Dec). We prefer that

clients have a set schedule per semester (i.e. Full time or Part time). The Clinical team will make

recommendations as to your child’s schedule based on assessment, however, ultimately the parents determine

the child’s schedule/availability.

20. Children must be picked up on time (i.e., 5 minutes before the end of the last session). In case of an emergency

(e.g., death in the family, car accident) or any changes, please call the center. A late fee of $5.00 will be assessed

for the first 15 minutes after the scheduled pick-up time and $1.00 per minute thereafter.

21. BI staff are not allowed to transport children under any circumstance. If there is an emergency then city

emergency staff will transport. Special permission can be granted for sessions to be conducted in the

community setting but parents will need to transport the child and remain in the community setting while

sessions take place. Also, families will be responsible for covering all costs associated with the outing for both

child and therapist. Therapists will travel to the community setting in their separate vehicle. Last, we avoid

conducting therapy in a “crowded” community setting due to safety concerns.

Page 6: Welcome Packet - Behavioral Innovations

6

22. BI employees are under an employment agreement with Behavioral Innovations. Therefore, BI employees

cannot enter into a separate employment agreement (dual relationship), arrangement for services or any other

services with the family. If an employee enters into such an agreement, the employee will be held accountable

and the family may be involved in the legal proceedings.

23. BI employees are under the BACB Professional and Ethical Guidelines, therefore the following is to summarize

their obligations under this code. Employees are not allowed to share their personal contact information such

as their phone number, therefore please contact the business contacts provided to you. Staff are also not

allowed to receive gifts from families. Observations of therapists are welcome but this should be requested

through the BCBA to ensure we follow our ethical guidelines and the therapist is practicing within their scope.

Parent training, training of other professionals etc. BCBA/BCaBA scope of practice.

24. Parents are to adhere to the policies and procedures in the parent handbook as well as the Financial Liability

form.

Parent Attestations and Consent:

25. I understand that in order for any correspondence to take place with my insurance company, I must obtain a

diagnosis code in writing from my child’s primary physician and I will provide a copy of the diagnosis for my

child’s file here at Behavioral Innovations. Diagnosis codes will be included on invoices ONLY if provided by

the child’s primary physician. Parents will also need to provide Behavioral Innovations with the child’s social

security number.

26. I understand for Behavioral Innovations to bill my insurance for services, BI will need to share any information

regarding services with my insurance company.

______I consent for Behavioral Innovations to provide any documentation to the insurance company as requested by

the insurance company or the parents.

_____ I am a private pay client and do not consent to Behavioral Innovations providing any information to my

insurance company.

It is the parent’s responsibility to keep Behavioral Innovations aware of any changes to their and/or their

child’s insurance coverage.

Page 7: Welcome Packet - Behavioral Innovations

7

27. Photography Consent:

______I give permission for Behavioral Innovations to take photographs of my child(children). I understand that

the photographs of my child(children) will be included in marketing materials by Behavioral Innovations. I

understand that my child may be included in photographs with other children, and I give permission for any

photo that includes my child to be shared through any marketing channel Behavioral Innovations chooses. I

understand that this is a voluntary agreement and will not affect my child’s therapy program and can be

changed at any time.

_____ I do not give permission for Behavioral Innovations to take photographs of my child. I understand that this

is a voluntary agreement and will not affect my child’s therapy program and can be changed at any time.

28. Videotaping Consent:

______ I give permission for BI to videotape my child(ren) during sessions for the purposes of training BI staff or

his/her parents/caregivers only. I understand that the videotapes of my child(ren) will used for training

purposes only. I understand that this is a voluntary agreement and will not affect my child’s therapy program

and can be changed at any time.

______ I do not give permission for BI to videotape my child(ren) during treatment. I understand that this is a

voluntary agreement, will not affect my child’s therapy program and can be changed at any time.

29. I understand that fees for services are subject to change.

30. I understand that the program requirements and structure are subject to change including but not limited to,

changes that may affect my child’s eligibility. If such changes are made parents will be notified in writing ASAP.

Staff Responsibilities

1. The Center will ensure that your child receives the specified number of hours of intensive behaviorally analytic

treatment, excluding holidays, child illness, client vacation(s) or emergency situations.

2. The Center is responsible for the supervision and on-going training of all staff therapists. Consultants monitor

programs, evaluate effectiveness, make programmatic changes/modifications and provide training to the

therapists.

Page 8: Welcome Packet - Behavioral Innovations

8

3. The Center is responsible for but is not limited to; conducting team meetings, parent training, developing

programs, implementing programs on a daily basis, monitoring and updating programs on a daily basis, and the

development of a data collection system and monitoring of that system.

4. BI adheres to the Behavioral Analysis Certification Board Guidelines for Responsible Conduct, therefore any

information related to a specific client will remain confidential at all times. BI embraces training of

professionals. Hence, your child’s confidentiality will be protected in any in vivo or videotaped sessions of your

child that is used for training purposes. Protection of confidentiality also applies to photography or video taken by

B.I., their ABLLS and their work samples, to be used for the purposes of marketing material on behalf of B.I. No

form of identification will ever be used; therefore, your child’s name will not be associated with the product info.

Lastly, data from your child’s prescribed treatment program may be used in general research to benefit autism

intervention and will not have information to reveal the identity of your child. Any research involving intervention

outside of consultant recommendations will be reviewed by the consultants and parents and an additional release

of consent will be signed.

5. The Center is responsible for notifying, in writing, the parent(s) of any service delivery changes.

I have read this service agreement and agree to abide by its terms and conditions.

_______________________________________________________ _____________________

Signature of Parent/Guardian Date

_______________________________________________________ _____________________

Signature of BI Representative Date

Page 9: Welcome Packet - Behavioral Innovations

9

Treatment Center Credit Card Authorization _____________________________________________________________________________ Client Name: Parent(s): I will pay payments by:

Credit Card Credit Card (Auto pay) Check (mail to 3100 Premier Drive #234 Irving TX 75063)

Payment Amount of $_________ or balance due __________ monthly Charge Credit Card on the 5th or 10th of each month. (please circle preference) Credit Card Information: Name: ________________________________ Phone: ________________________________ Billing Address: __________________________ __________________________ Credit Card: ___Visa ___ MasterCard ___ Discover ___ Amex (check one) Card Number: __________________________ Expiration Date: ____________ CSV (3 digits on back, 4 digits on front for Amex): ________ Name as appears on Credit Card: ________________________________ I authorize a monthly recurring charge by Behavioral Innovations against my credit card as indicated above. This authorization remains in effect until I provide written authorization of its termination. _______________________________________________________ ______________

Signature Date

Page 10: Welcome Packet - Behavioral Innovations

10

Last Name: Dates Updated:

First Name

Medication: Effective dates:__________ to __________ Office use only

Dosage Amt:__________________________ □Master list

When/Frequency:______________________ Please Administer until □Admin notified

How to deliver:_________________________ □Regimen complete □Team notified

Side effects to be aware of:______________ □Otherwise notified

_____________________________________ __________________________

Any other special instructions:____________ Parent Signature to Authorize

_____________________________________

_____________________________________ _________________________

BI representative

Medication: Effective dates:__________ to __________ Office use only

Dosage Amt:__________________________ □Master list

When/Frequency:______________________ Please Administer until □Admin notified

How to deliver:_________________________ □Regimen complete □Team notified

Side effects to be aware of:______________ □Otherwise notified

_____________________________________ __________________________

Any other special instructions:____________ Parent Signature to Authorize

_____________________________________

_____________________________________ _________________________

BI representative

Medication: Effective dates:__________ to __________ Office use only

Dosage Amt:__________________________ □Master list

When/Frequency:______________________ Please Administer until □Admin notified

How to deliver:_________________________ □Regimen complete □Team notified

Side effects to be aware of:______________ □Otherwise notified

_____________________________________ __________________________

Any other special instructions:____________ Parent Signature to Authorize

_____________________________________

_____________________________________ _________________________

BI representative

Medicine Authorization Form ______________________________________________________________________________

Dates Updated:

Client:

Staff members of Behavioral Innovations are authorized to seek emergency medical treatment on behalf of my child if neither parent can be reached. _______________________________________________________ _______________ Signature of Parent/Guardian Date

Page 11: Welcome Packet - Behavioral Innovations

11

Benadryl Permission Form (Optional) ______________________________________________________________________________ Client:

I give permission for my child’s therapist, consultant, or team member of BI to administer the appropriate dos of

Benadryl, as indicated on the bottle of medicine, to my child in the case of suspected insect bite(s) or allergic

reaction.

_______________________________________________________ _______________

Signature of Parent/Guardian Date

Authorization for Medical Emergency Treatment ______________________________________________________________________________

Client:

Staff members of Behavioral Innovations are authorized to seek emergency medical treatment on behalf of my

child if neither parent can be reached.

_______________________________________________________ _______________

Signature of Parent/Guardian Date

Page 12: Welcome Packet - Behavioral Innovations

12

Authorization to Pick Up Form ______________________________________________________________________________ Client: Date:

Parent has authorized the following people to pick up their child:

1._____________________________ Relationship to the child: _______________________

Contact Info:__________________________________________________________________ _

2._____________________________ Relationship to the child: _______________________

Contact Info:__________________________________________________________________ _

3. _____________________________ Relationship to the child: _______________________

Contact Info:__________________________________________________________________ _

Any other special pick up instructions:

_______________________________________________ _____________________

Signature of Parent Date

Page 13: Welcome Packet - Behavioral Innovations

13

Non-covered Services Waiver ______________________________________________________________________________

Non-covered Services (All non-Tricare clients must fill this form out)

Client Name: ______________________________ ____________ Parent Name(s):___________________________________ _____

Service Description

Service: Cost: No Show/Cancellation (less than 24 hours’ notice) $25.00/instance Late Payment $25.00/month of non payment Returned Check Fee $25.00/returned check Enrollment Fee $150.00 one-time payment Breach of 30 day notice $25.00/date of session missed Late Pick up (First 15 mins) $10.00/instance Late Pick up (16+ mins) $1.00/minute Respite $10.00/hour

Provider Information

Name: Behavioral Innovations Address: __________________________________________________________ I hereby affirm that I have been informed and I understand that these services are excluded or excludable under my insurance and therefore all costs outlined above are not allowable expenses under my insurance. By signing this Non-covered Services Waiver, I am hereby agreeing in advance, in writing, to accept full financial responsibility for all costs associated with non-covered services, described in this document under “service description” and performed by Behavioral Innovations. Parent Name: __________________________________________________________________ Parent Signature: _______________________________________ Date: ____________________

Page 14: Welcome Packet - Behavioral Innovations

14

Page 15: Welcome Packet - Behavioral Innovations

15

Emergency Information Form ______________________________________________________________________________ Note: This form should be updated when starting and each semester. Child Name:_________________ _ Date:__________________ Parent(s):_____________________________________________________________ Address:______________________________________________________________ Mom phone #:_________________________Dad phone #:______________________ Mom’s email:_________________________ Dad’s email:________________________

Allergies Allergic to: _____________________ Response:_____________________________ Allergic to:____________________ _Response:_____________________________ Allergic to:_____________ ________Response:_____________________________ Seizures Seizures? ____ Yes _____NO If yes, please list your requests as it relates to seizures: WHO TO CONTACT: 1st Person:_____________________________ Relationship to Child:_______________ Phone:_________________________________ 2nd Person:_____________________________ Relationship to Child:_______________ Phone:_________________________________ 3rd Person:_____________________________ Relationship to Child:_______________ Phone:_________________________________

Page 16: Welcome Packet - Behavioral Innovations

16

Patient Bill of Rights and Responsibilities ______________________________________________________________________________ Client: Monarch Behavioral Therapy, BI (Behavioral Innovations) is dedicated to helping children with developmental

disabilities achieve their potential in family, community and school life. We care about the dignity and welfare of

all who receive services from us.

Although these rights are written for the patient, in most cases they also apply to the patient's parents or legal

guardians. We expect staff, patients, families and visitors to act in a reasonable and responsible way at all times.

If you have a concern about any of these rights or responsibilities, you may discuss it with the staff involved, their

supervisor or our Clinical Director. If you are still concerned, you may also speak with the executive director's

office by coordinating with the Clinical Director.

Your Rights:

You have the right to considerate, respectful care at all times and under all circumstances, with recognition

of personal dignity.

You have the right, within the law, to personal and informational privacy.

You have the right to expect reasonable safety insofar as the center’s practices and environment are

concerned.

You have the right to verbal and written communications.

You have the right to refuse treatment to the extent permitted by law. When the refusal of treatment by a

patient, or their legally authorized representative, prevents the provision of appropriate care in accordance

with professional standards, the relationship with the patient may be terminated upon reasonable notice.

Page 17: Welcome Packet - Behavioral Innovations

17

You have the right to expect that Monarch Behavioral Therapy (Behavioral Innovations) staff is competent

to obtain and interpret information in terms of your needs and to have an understanding of the range of

treatment needed.

The family and/or guardian of patients have the right to be involved in the patient’s continuing care.

The family and/or guardian of patients have the right to be involved in the patient’s continuing care.

You have the right to assistance for conflicts regarding services rendered. If applicable, the assigned

Monarch Behavioral Therapy (Behavioral Innovations) provider should always be made aware of any

conflict. If resolutions of conflict cannot be achieved with the patient/family through the professionals

involved, the patient/family has the right to request a meeting with the Clinical Director who has the

ultimate authority in resolving conflicts.

You have the responsibility to:

Provide, to the best of your knowledge, accurate and complete information about present complaints, past

illnesses, hospitalizations, medications and other matters relating to your child’s health.

Follow treatment plans recommended by the Monarch Behavioral Therapy (Behavioral Innovations)

practitioners.

Be responsible for your actions if you refuse treatment of do not follow the practitioner’s instructions.

Assure that the financial obligations of your child’s health care/service are fulfilled as promptly as possible.

Be responsible for keeping your insurance information/coverage/policy numbers up to date with

Behavioral Innovations.

Be considerate of the rights of other patients and the Monarch Behavioral Therapy (Behavioral

Innovations) staff for assisting in the control of noise and number of visitors.

Page 18: Welcome Packet - Behavioral Innovations

18

Be respectful of the property of the other persons and the Monarch Behavioral Therapy (Behavioral

Innovations) treatment facility.

_______________________________________________ _____________________

Signature of Parent Date

Page 19: Welcome Packet - Behavioral Innovations

19

Page 20: Welcome Packet - Behavioral Innovations

20

Invoicing

CentralReach is the system Behavioral Innovations uses for invoices, record storage, schedules, secure HIPAA

compliant messaging and questionnaires we need families to complete for therapy purposes. Below is your

CentralReach login that you will use throughout your time as a client of Behavioral Innovations.

CentralReach Username ___________________________________________

CentralReach Temporary Password ____________________________________________

You can access you client portal by going to www.centralreach.com and entering the log in criteria above. Once

logged in you can click on the Billing Module, which has a $ symbol, to view your invoices as shown below.

You can also pay invoices in full through the client portal. For partial payments, please see your local Business

Manager. Here are some brief instructions on payment through the client portal (CentralReach):

To the right of every invoice there will be a button that says Pay.

After clicking Pay, you will have the option to make the payment using a saved credit card, or with a new

card.

o If you choose to pay with an existing/saved card you’ll only need to re-enter your credit card’s

CVC number.

o If you choose to pay with a new card you’ll need to enter in the credit card’s info, billing info, and

add a name for the card.

Click the Pay Invoice button.

For any additional invoice questions, please contact your local Business Manager.

Page 21: Welcome Packet - Behavioral Innovations

21

Insurance Billing/Reimbursement

Behavioral Innovations is “in network” with some insurance companies. If we are considered “in network” and

have a contractual agreement with your particular insurance company, we will be happy to courtesy bill your

insurance company for services provided. If the insurance company denies payment, you are responsible for

payment (see financial liability agreement). In order to bill your insurance company we will need a copy of your

insurance card, the subscriber’s date of birth, a copy of your child’s diagnosis from a physician, and a

prescription for ABA services from your physician.

If we are unable to courtesy bill your insurance company, you personally may be able to submit receipts directly

to your insurance company for services rendered to obtain reimbursement. The invoice that you receive at the

beginning of each month will not be sufficient for your insurance. We will be happy to provide you with

receipts after the services are delivered and paid. The receipt will need to contain dates of services therefore

services will need to be delivered first.

Assignment of Benefits

Patient (Client) Name: Policy Holder

Name: Company:

I hereby authorize payment of benefits, otherwise payable to me, for services rendered by the provider,

Behavioral Innovations, a Monarch Behavioral Therapy Company, and/or as indicated on the enclosed bill or

claim. I understand that I am financially responsible to the provider for all charges not covered or not paid by

my health care benefit plan within sixty (60) days after billing. I also understand that the provider may require

that I pay the estimated non- covered charges before the completion of an insurance bill or claim. This

Assignment of Benefits is valid and in force until I cancel it in writing.

Policy Holder Signature Date

Parent/Guardian Signature Date

Page 22: Welcome Packet - Behavioral Innovations
Page 23: Welcome Packet - Behavioral Innovations

23

Table of Contents

Contents

Page

Who We Are

2

Our Mission

2

Our Staff

3

Behavioral Innovations Curriculum

4

Health and Safety

4

Parent Involvement

5

Parent Complaint Procedure

5

Communication

5

Hours

5

Holidays

6

Inclement Weather

6

Session Preparation & Effectiveness

6

Community Outings

7

Birthdays and Special Events

7

Ethical and Professional Considerations

7

Payment Information

8

Note: Handbook will be updated as needed and you will receive an updated version

Last updated: November 2016

Page 24: Welcome Packet - Behavioral Innovations

24

Introduction

Dear Parents, This book is intended to acquaint you with our company, philosophy, staff, and policies. We hope the information will help us work together so that your child’s development will be well guided and happy. Please remember that you are always welcome to Behavioral Innovations. We encourage you to be involved in your child’s learning as often as possible because you are your child’s first and most important teacher! Sincerely, Behavioral Innovations Team

Who We Are

Behavioral Innovations (BI) originally began in 2000 as a consulting firm for families of children with special needs or behavioral deficits, and school districts or regional centers throughout the Dallas/Ft. Worth Metroplex. In 2003, Behavioral Innovations began the first on-site Treatment Center in DFW Metroplex in which children could receive up to 35 hours per week of direct therapy based on Applied Behavior Analysis (ABA) principles. In 2009, we broadened our services to include an in-home ABA program. Behavioral Innovations has expanded services across the state of Texas and Oklahoma to include San Antonio, Benbrook, Austin, Keller, Garland/Rowlett, and East Texas. The passion of the directors, staff and those involved with BI is to continue to expand services across Texas and the United States so that families in need can access services. The philosophy guiding our daily operation is driven by your child with his/her development in mind. We strive to provide an individualized, integrated model of service delivery combining all aspects of behavioral methodology. As such, there is no preference given towards any particular method(s) except those methods that have been empirically validated, or supported in research. We promote the use of reinforcement procedures to increase both the rate of skills learned and the overall bank of skills your child has. The primary focus of all interventions is functional skill development based on the specific needs of the family and child.

Our Mission

Our mission is to change the lives of children and families with special needs, by helping them see, discover, and experience this world as a world of imagination, possibility, and healing.

Page 25: Welcome Packet - Behavioral Innovations

25

Our Staff

Our staff consists of Regional Directors, BCBAs, Treatment Managers, Office Managers, RBTs and RBTs in training. Our staff has experience in developing and implementing individualized treatment plans for children with special needs including: Autism, Intellectual Developmental Disorder, Attention-Deficit Disorder, feeding problems, emotionally disturbed, language delays, Downs-Syndrome, and behavioral problems. Each therapist has experience working with children and has completed a training protocol, which requires demonstration of competency in behavioral analytic practices, analytical thinking and teaching procedure and implementation.

Behavioral Innovations Curriculum

Our goal is to have an individualized, integrated curriculum. Each child’s curriculum is developed after an assessment. We utilize goals from the Vineland Adaptive Behavior Scales, Verbal Behavior Milestone Assessment and Placement Program (VBMAPP), Assessment of Basic Language and Learning Skills (ABLLS), Behavioral Interventions for Young Children with Autism (BIYCA), A Work in Progress, Teach Me Language, Skills Streaming, An Activity Based Approach to Early Intervention, Teaching Children with Autism, The Power of Positive Parenting and developmental checklists.

Health and Safety

Safety is our number one priority at Behavioral Innovations. There are several ways in which we ensure the safety of all involved:

Incident Protocol CPR certified team Regular safety trainings Staff background checks (local, state & federal level) Staff drug screening and reference checks Child medical history file (immunizations, allergies, past injuries and illness) Handwashing protocol Good hygiene of self and environment fostered

Sick Policy

To protect your child, family and staff, we ask that parents help us by contacting the Treatment Manager and cancelling your child’s scheduled session if they have experienced any of the following symptoms over the last 24 hours:

Undiagnosed rash Fever (over 99.5 degrees F) (without usuage of fever reducing medications) Vomitting and/or diarrhea

Some illnesses exclude a child from attending school by law. This applies to therapy sessions as well:

Page 26: Welcome Packet - Behavioral Innovations

26

Infectious Conjunctivitis Scabies Infectious Diarrhea Lice Impetigo Ringworm Chicken Pox Strep Throat Hepatitis A Green Mucus Scarlet Fever

If your child or anyone in the home exhibits any one of the symptoms listed above while a therapist is in the home, the therapist is obligated to cancel session in the best interest of staff health and safety.

Parent Involvement

We encourage you to observe and/or with your child during sessions. While some involvement is required, we suggest that you look for many opportunities to be involved in your child’s program. Parent involvement is required for the following:

Parent/Guardian (over 18 years) must be present for the entire length of session Parent meetings (typically includes updates, parent training, staff coordination, etc.) Provide Internet and needed materials for sessions including reinforcers, teaching

materials, printed materials.

Parent involvement is optional but strongly encouraged for the following: Observation of sessions

Please refrain from engaging your child or the therapist while a therapist is intervening with a difficult behavior (e.g., aggression, tantrums). This is especially important in the beginning stages of therapy. If you have any questions, concerns, or would like more training to better address difficult behaviors yourself, please contact the Coordinator.

Parent Complaint Procedure

It is a policy of Behavioral Innovations to welcome and accept parent feedback. We arrange several opportunities throughout treatment for parents to provide us with feedback through team meetings or anonymous surveys. We encourage parents to bring concerns to the Supervising Clinician/Coordinator first, and then the Clinical Director if no resolution is reached. Parents can contact us by phone or email and should expect a reply within a reasonable response time.

Page 27: Welcome Packet - Behavioral Innovations

27

Communication

There are several opportunities for Parent and Staff communications. Here are some different ways in which we communicate with you, and you will be able to communicate with us:

Daily Progress Note Scheduled Observations by BCBA Monthly Parent Meetings

Email Phone BI Company Facebook & Website

Hours

Behavioral Innovations collaborates with families to create schedules that match both staffing and family availability. Behavioral Innovations provides services year-round, Monday through Friday from 8:00 A.M. to 7:00 P.M., with availability on weekends upon request and staff availability. We ask that should a parent be delayed starting session, they please call, or email the Office Manager as far in advance as possible so that staff can be notified.

You will be charged a service fee of $25 for every missed session. If a session is cancelled and rescheduled at least a week in advance of the cancelled session, it will not be counted as a missed session.

Holidays & Planned Non-Service Days

You will receive a calendar each year. We are generally closed the following holidays and non-service days:

Good Friday Memorial Day Fourth of July Labor Day

Thanksgiving Christmas Eve & Christmas Day New Years Eve & New Years Day Staff training/planning days, conferences, training

seminars

Page 28: Welcome Packet - Behavioral Innovations

28

Inclement Weather Policy

Behavioral Innovations’ number one priority is providing the best service to our clients. Our weather policy is such that if the school district in which your home is located is closed, then Behavioral Innovations will also be closed. If the school district opens on a delay, in-home therapy services will also open at the same delay time as the school district. If the school district closes early, in-home therapy services will also end early as the school district. Behavioral Innovations will also take into consideration the school district that the therapist resides in, works in, etc. in order to determine safety of travel by the BI therapist. Any changes due to inclement weather closings that effect therapist availability will be communicated to the family as soon as possible. Behavioral Innovations will also determine if a Saturday make-up day is possible for those students missing the day of therapy due to weather conditions.

Session Preparation & Effectiveness

Behavioral Innovations values your time and seeks to maximize the time we do spend with your child as well as our efficiency. This includes making sure that your child is ready and prepared for session. This may include but it is not limited to:

Comfortable clothing suitable to the weather and active play Awake from any naps at least 15 minutes before the start of session Child should not require a meal during session unless it is included as a goal BI Staff do not administer medication and this should be given by parents Specified reinforcers (e.g., edibles/toys that are for session only) available for staff Environment condusive to therapy depending on child’s needs

About the first and last 10 minutes of session (varies based on child needs), the therapist will be using this time to setup paperwork, prepare materials, record data, and/or create progress notes. These are all important components to the process of ABA and supervision, as we rely heavily on current data and communication.

Community Outings

Behavioral Innovations supports the use of community outings to help foster your child’s individualized skills. Community outings might be used for goals such as joining new peer groups, playing near or with others in the community, ordering and paying for a meal, or generlizing mastered skills like handwashing or gaining someone’s attention.

Page 29: Welcome Packet - Behavioral Innovations

29

Outing Guidelines:

Must first be approved by the Supervising Clinician/Coordinator Must notify the Treatment Manager of change in location of session Must drive with yourself and your child in a separate vehicle from the therapist You can meet at home and then go to the outing or go directly to the outing Avoid caravanning and make sure appropriate directions are given in advance Please discuss with the therapist in advance how you would like them to be

introduced if someone approaches (e.g., “therapist”, “friend”, “teacher”) If there are fees, the parent is responsible for covering all community costs for their

child.

Birthdays & Special Events Behavioral Innovations supports a friendly, open and collaborative working environment with our staff. On the occasion that a session falls during a birthday or special event, the session may be held if it is appropriate and goals may still be targeted. Again, be sure to discuss in advance how the therpist will be introduced to others. Please be advised, BI Staff do not attend birthday parties or other special events that are not within bounds of a typical therapy session. In addition, Behavioral Innovations policy prohibits therapist giving/receiving gifts to/from clients and/or families.

Ethical & Professional Considerations

Our staff is bound by the following guidelines related to ethical and professional standards:

Behavior Analyst Certification Board Professional and Ethical Compliance Code (see www.bacb.com for the latest code of ethics)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) BI’s Notice of Privacy Practice

Here’s how this may affect you and your family:

We will not discuss your child with others Our staff will keep your child’s information confidential Our staff will not be allowed to engage in dual relationships such as babysitting If you would like the Coordinator to contact other professionals (e.g., teachers,

occupational therapist, speech-language pathologist), BI requires a release of information for both parties

Payment Information

Please see your service agreement for specific information related to payments and our billing process. We ask that you direct questions related to this process to the Business Manager ONLY. Payments are to be given to the Business Manager and not the Clinical Staff.

Page 30: Welcome Packet - Behavioral Innovations

30