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{Company Name}, LLC   recognizes and respects the value of cultural diversity and will ensure that your ethnic or cultural customs, practices, and beliefs, sexual orientation, gender, gender identity, gender expression, disability, and/or community differences will be respected by all staff. 

{Company Name}, LLC   will take reasonable steps to ensure that persons with Limited English Proficiency (LEP) have meaningful access and an equal opportunity to participate in our services, activities, programs. The policy of Innovative Behavior Options, LLC is to ensure meaningful communication with LEP clients and their authorized representatives involving their treatment. The policy also provides for communication of information contained in vital documents, including but not limited to, waivers of rights, consent to treatment forms, financial and insurance benefit forms, etc. All interpreters, translators and other aids needed to comply with this policy shall be provided without cost to the person being served, and clients and their families will be informed of the availability of such assistance free of charge. 

Language assistance will be provided through use of competent bilingual staff, staff interpreters, or technology and telephonic interpretation services. All staff will be provided notice of this policy and procedure, and staff that may have direct contact with LEP individuals will be trained in effective communication techniques, including the effective use of an interpreter.   

*Signature

Client Handbook Part 1

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What is ABA?

 

Applied Behavior Analysis is a scientifically validated approach to understanding behavior and how it is affected by the environment. In this context, “behavior” refers to actions and skills, and “environment” includes any influence - physical or social - that might change or be changed by one’s behavior.

Since the 1960’s, therapists have been applying behavior analysis to help children with autism and related developmental disorders. Through the decades of research, the field of behavior analysis has developed many techniques for increasing useful behaviors and reducing those that may cause harm or interfere with learning.

On a practical level, the principles (how learning takes place) and methods of behavior analysis have helped many kinds of learners acquire many different skills. When the desired behavior is followed by a reward, the behavior is more likely to be repeated. Techniques used within ABA can be used in structured situations, such as a classroom lesson or “everyday” situations such as family dinner time or the neighborhood playground. Therapy sessions can include one-on-one interaction or group instruction.

Applied Behavior Analysis strives to bring meaningful and positive changes in behavior- from healthier lifestyles to the mastery of a new language - from toddlers through adulthood.

www.autismspeaks.org
Links for more information on behavior, behavior analysis, and behavior therapy:
http://www.centerforautism.com/aba/whatisaba.asp
http://www.abainterNational.org/ba.asp
http://www.behavior.org/behavior/
http://seab.envmed,rochester.edu/jaba/
http://www.handsinautism.orq/pdf/whatisABA.pdf
 

Client Handbook Part 2

 

Services in Applied Behavioral Analysis

Our team provides a range of services to help your child and your family. All programs are created from research-based strategies and developmentally appropriate curriculum. The teaching of treatment goals is done in a one on one or group setting in a natural environment (NET) and Intensive Teaching (ITT) settings. There is an emphasis on Verbal Behavior. These services include:

Social Skills Training:

• One-on-one Settings
• Play dates - facilitated peer play
• Social Groups - small groups customized for your child, his/her goals, with his/her peers, and in his/her community

• Toy play
• Pretend/Imaginative Play
• Cooperative Play

• Mand training (Requesting) American Sign Language (ASL)
• Picture Exchange Communication System (PECS)
• Assistive Technology
• Vocal Speech
• Conversational Language
• Commenting
• Turn Taking
• Staying on Topic
• Decrease echolalia (repetitive speech) and increase functional language by teaching replacement language.
• Decrease problematic behavior by teaching increasing functional language skills and teaching replacement language.

Functional Behavior Assessment: Functional Behavior Analysis (FBA) is an attempt to look beyond the obvious interpretation of behavior as "bad" and determine what function it may be serving for a child. Truly understanding why a child behaves the way he or she does is the first, best step to developing strategies to stop the behavior.

Behavior Intervention Plan: Behavior Intervention Plan (BIP) takes the observations made in an FBA and turns them into a concrete plan of action for managing a child's behavior. A BIP may include ways to change the environment to keep behavior from starting in the first place, provide positive reinforcement to promote good behavior, employ planned ignoring to avoid reinforcing bad behavior and provide supports needed.

Assessments: VB-MAPP, ABLLS-R, Brigance Developmental Inventory, informal parent/ teacher interview & observation, social skills inventory, reinforcer inventory, sensory integration checklist and other developmental checklists. Assessments are used to guide program development. They are NOT used to diagnose.

"Potty Party": We train parents how to provide a child-specific plan for toilet training. Toilet training can be challenging; we are here to support and encourage this process. We offer several packages of various intensity levels. Prices may differ from regular sessions.

• Rapid Toilet Training (3 day approach based on methods of Azrin and Foxx).
• Schedule/Habit training
• Parent training model

Client Handbook Part 3

 

Daily Living Skills: We assist in teaching your child day-to-day self-help skills; for example, dressing, eating, grooming, household chores, etc.

Other:  We also can assist in community outings, family activities, doctor appointments, haircuts, developing schedules/routine, and improve sibling relations.

School Consultation:

• Shadow Services: one-on-one assistance in group settings, such as private schools, daycares, camps and learning centers. Shadowing can assist with behavior, communication skills, social skills, etc. Shadow services are only optional per staff availability.
• In School Facilitation: help to collaborate with teachers and professionals to accomplish common goals.
• Training Opportunities: paraprofessional training, teacher workshops, etc.

IEP Review: Assist in creating lEP goals with the parents, teacher, and administrator. We can also attend IEP meetings to help advocate in the best interest of the child. Collaborate with parents to understand how to navigate the IEP process.

Academic Assistance: Assist parents and teachers in identifying strengths, weaknesses and possible skill deficits with academics and help to provide strategies and break down skills for your child to have more success with schoolwork and homework.

Program Development: This includes ongoing assessments, data compilation, task analysis, program updates, reports, review any given documents, development of treatment plans, and sometimes direct instruction training program management. A description of the completed program development tasks, including time spent, during each month will be attached to the invoice each month. Time needed for for program development is “10-20% of client’s direct service hours” rather than 4 hours each month to make in more inline for what we provide in terms of program development. This time can be in addition to the weekly allotment of hours or can be done in place of a session. Please note that prices for program development are different from session prices. Program Development allows us to review your child's progress, research, and update any new plans your child may need.* This service is not optional. It is mandatory with any other service.

Parent Training: We also offer intensive one-on-one parent training. This consists of basic principles and techniques of ABA specific to your child's current needs to increase your child's independence, daily living skills, and communication. We coach parents through behavior problems, help parents maintain consistency, help them learn strategies to improve compliance and following directions, deal with behavior, and help provide appropriate consequences.* This service is not optional. It is mandatory with any other service.

Behavior Analyst Certification Board (BACB) guidelines.

{Company Name} follows the Behavior Analyst Certification Board (BACB) guidelines. Within these guidelines, clients have the right to effective behavior treatment, which includes individual’s rights, professional relationship and informed consent.

An individual has a right to....

• A therapeutic environment
• Services whose overriding goal is personal welfare
• Treatment by a competent behavior analyst
• Programs that teach functional skills
• A behavioral assessment and ongoing evaluation
• The most effective treatment procedures available

Professional relationship requires:

• Confidentiality
• Protecting the client's dignity, health, and safety
• Helping the client select outcomes and behavior change targets
• Maintaining records
• Advocating for the client
• Providing necessary and needed services
• Evidenced-based practice and least restrictive alternatives
• Not a conflict of Interest

Guideline for "Informed Consent" is as follows: Informed consent means that the potential recipient of services gives his/her (in our case the parent/ guardian) explicit permission before any assessment or treatment is provided. Informed consent requires more than obtaining permission. Permission must come following full disclosure and information is provided to the participant. For consent to be valid:

• Person must demonstrate the capacity to decide
• The person's decision must be voluntary
• The person must have adequate knowledge of all salient aspects of the treatment.

More information can be found at www.BACB.com

Client Handbook Part 4

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STAFF DESCRIPTIONS

Clinic Director/Manager: The Director working with the BCBA, designs and develops all of the teaching programs and sets priorities for your child’s intervention program based on the goals that have been set for your child and family. The Director can also coordinate services with other providers your child may see, if you desire. 

BCBAs:/BCaBAs:  The BCBA/BCaBA Supervisor serves as the primary contact person for your family and the professionals working with your child. The BCBA/BCaBA Supervisor will help the Director ensure that the ABA Therapists are very well trained and that they implement your child's program as the Director prescribes. The BCBA/BCaBA Supervisor reviews charts/data showing your child's progress, lEP's, in addition to attending monthly team meetings, the BCBA/BCaBA Supervisor always has up-to-date information concerning your child's progress. Additionally, because the BCBA/BCaBA Supervisor also implements your child's intervention program with your child at least once each month, they are also able to provide you with important and useful information that will inform treatment decisions concerning your child's progress. In the case a BCBA/BCaBA Supervisor is not available the above roles and responsibilities may be split between the Director and the LineTherapists.  

ABA Therapists:  The ABA Therapist works with your child several times each week, and is fully trained by Innovative Behavior Options, LLC. The ABA Therapist ensures that the Director and BCBA/BCaBA Supervisor have all the information they need to manage your child's program effectively. Everyone works together to make sure that your child is receiving the best possible program based on individual goals. Duties and responsibilities of team members may vary and are not limited to the roles as stated above. There is no guarantee that the same therapist/BCBA will be assigned to your child's case for the entire time you receive services at Innovative Behavior Options, LLC. Innovative Behavior Options, LLC may change staff assigned your child's case at anytime as needed. I acknowledge that my child’s therapist team may change at any time.
Parents acknowledge that each client receiving services from Innovative Behavior Options, LLC has an individualized treatment plan (ITP). Each program is developed after assessments are completed; both direct and indirect. Each program is continually evolving based on the child's progress. The Director is ultimately responsible for making programmatic decisions. Parents will be notified of any changes and discussion may take place. Therapists are not allowed to change the program without the Director’s approval.  

Client Handbook Part 5

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COMMUNICATION

Communication is a vital role for many several reasons. Our goal at {Company Name} is to respond to all emails, phone calls or texts within 24 hours during regular business hours*. There may be times that we respond with a notification stating that we may need more time to respond.

Parents acknowledge replying to phone calls or emails from staff members within 24 hours. If you do not have time to respond to the communication from a staff member within 24 hours, email, call or text to indicate when you will be able to respond so that we are aware that you received the communication.

*Business hours are from 8:00am to 6:00pm Monday-Friday.
 

• For Schedules: scheduling@behavioroptions.com
• For Billing: billing@behavioroptions.com
• General information: info@behavioroptions.com
• Company Complaint Website

*Parent/Caregiver's Name

 

Client Handbook Part 6

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Confidentiality Policy

{Company Name}, LLC provides direct services to clients and their families. Consequently, we are dealing with health information on a daily basis.{Company Name}, LLC is bound by HIPAA regulations that require organizations to protect the sensitive health information of their clients. Protected Health Information (PHI) includes "any information, whether oral or recorded in any form or medium" that "relate(s) to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual." Therefore, in order to ensure the confidentiality of every client that we treat, we have developed certain standards of care that employees must be aware of and agree to.
Therefore, in order to ensure the confidentiality of every client that we treat, we have developed certain standards of care that employees must be aware of and agree to. Employees acknowledge the following policies about clients: employees will never disclose or discuss protected health information, client care, programming, client name, etc. with anyone who is not employed by {Company Name}, LLC; employees will take every precaution to ensure that data sheets, log books, or other sensitive documents that could reveal a diagnosis is protected (e.g., never left out, left in a car in a visible location); employees will never communicate or publish protected health information of clients including names and images in physical or electronic form without prior written consent of the client and {Company Name}, LLC.
All records, including but not limited to medical and psychological reports, videotapes, DVDs, photographs, voice recordings, data and information related to client ("Confidential Information") are property of {Company Name}, LLC. Team members shall not disclose any Confidential Information to any person or use any Confidential Information for the benefit of the team member or any other person, except with the prior written consent of the {Company Name}, LLC.
Due to the sensitive nature of information it is imperative that {Company Name}, LLC keep sensitive information confidential. Any information about your children or family will be shared on a "need to know" basis only. Thus, {Company Name}, LLC is very sensitive about discussing your child's developmental needs and your family information in public places. Your client information will not be left unattended at any time (i.e., session notes, data sheets, binders). All devices (i.e., phones, ipads, computers) will have auto-lock and password enabled at all times. In the case that a device is missing or stolen the team member will notify the director immediately. {Company Name}, LLC has the capability of erasing all of its electronic devices to avoid a breech of sensitive information. Your client information will not be shared on any forms of social media sites. Emails containing sensitive information sent outside of the {Company Name}, LLC network to authorized professionals will be password protected.  

Client Handbook Part 7

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Notice of Privacy Practices

This notice describes how medical/mental health information about you may be used or disclosed and how you can get access to this information. Please review it carefully.

{Company Name} must maintain the privacy of your health information and to provide you with this notice. You will be asked to sign a Release of Information Form. Once you have signed the Release of Information Form, {Company Name} staff members may use or disclose your Protected Health Information (PHI) for purposes of diagnosis, treatment, obtaining payment, or to conduct healthcare operations. For example, to receive payment for our services, {Company Name} must provide information to the funding source being used.

Other permitted and required uses and disclosures that may be made without your consent, authorization, or opportunity to object:

Abuse or Neglect: If any {Company Name} member suspects abuse or neglect of a child and elder, he/she is mandated to make a report to the appropriate public authorities.

Danger: If a {Company Name} staff member suspects that you are in imminent danger of harming yourself or someone else, he/she is mandated to make a report to the person at risk to the public authorities.

Legal Proceedings: {Company Name} staff members may disclose PHI in response to a court order or subpoena or certain other legal proceedings.

You have the following rights regarding PHI {Company Name} maintains about you.

Right to Inspect and Copy: You have the right to inspect and request copies of information that may be used to make decisions about your care. Usually, this includes demographic and billing records but does not include case notes. To inspect and receive copies of information, you must submit a request in writing. If you request a copy of the information, {Company Name} may charge a fee for the cost of copying, mailing, or other supplies associated with your request. {Company Name} must respond to your request within fifteen days of receipt.

Right to Amend: If you feel that PHI about you is incorrect or incomplete, you may ask {Company Name} to amend the information. You have a right to request an amendment for as long as {Company Name}keeps the information. Your request for amendment must be in writing and must provide a reason supporting your request.

Right to an Accounting of Disclosures: You have the right to request an Accounting of Disclosures regarding information that {Company Name} staff members have made about you. You must submit your request in writing to the address below. Your request must state a period for the disclosures, which may not be longer than six years and may not include dates before April 14, 2014.

Right to Request Restrictions on Uses and Disclosures: You may request that disclosure of confidential information be limited. If {Company Name} is unable to agree to that restriction, we can discuss other options, such as referral to another counselor.

Right to Limit Reception of Confidential Information: For example, you may request that {Company Name} staff members only contact you at a certain telephone number or address. You do not have to give a reason for your request.

Right to a Paper Copy of this Notice of Privacy Practices: You have a right to a paper copy of this signed notice.

Other uses and disclosure of PHI and any disclosure of Case Notes will be made only with your written authorization. After such authorization is given, you may revoke that authorization at any time from future use. This notice may be amended as needed to comply with federal, state, and professional requirements.

Client Handbook Part 8

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Mandated Reporter Disclosure

All behavioral staff for the in-home program operated by {Company Name} are mandated reporters as deemed so by State state rules, regulations, and laws. This is true of all social workers, teachers, etc., and should not restrict the work to be completed. This is a state law designed to protect children from injury, and should not be viewed as means to harm parents and caretakers.

This form shall serve as a reminder to the family of this fact, and shall also provide insight into what this disclosure means. This disclosure shall serve as part of the client education regarding the program, and the client information packet.

Being Deemed a mandated reporter, the Behavior Therapist for the {Company Name} program is required by law to report any and all allegations, reports, and suspicions of child abuse, neglect, and maltreatment to the appropriate identified governing body.

Child Protective Services is the governing body identified in the state of Virginia regarding cases of child abuse, neglect, and maltreatment, and the Behavior Therapist is required and shall, therefore, report the incidents mentioned above to the National Hotline for Child Protective Services.

Any report to Child Protective Services, where deemed necessary by them, shall constitute a separate case from the one managed by {Company Name} intensive in-home program. For this reason, it should be noted that the Behavior staff shall only participate in cases as required and requested by Child Protective Services. The intensive in-home program operated by {Company Name} shall play no part in decisions made by Child Protective Services and should be viewed as a separate organization from Child Protective Services.

The client shall sign a Mandated Reporter Disclosure Receipt Form that shall be kept in the client's file as evidence that the information mentioned above has been provided to the client and family.

Client Handbook Part 9

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Schedules

Therapists cannot change schedules without the Director’s consent; when developing schedules, there are many matters considered.

Cancellations

Cancellations or request to re-schedule a session must be made at least 24 hours before the start of your scheduled session. If you fail to give 24 hours’ notice, you will be charged $60.00 for each canceled appointment. The penalty does not apply in the case of illness or inclement weather. If for any reason (other than sudden illness) the client needs to end a session early, the remaining time qualifies as a less than 24-hour cancellation and may be billable. Insurance carriers are not responsible for missed appointment fees.

In the case of a cancellation with less than 24 hours’ notice, immediately contact the RBT and the supervising BCBA and follow up with a phone call to the therapist who would be working the session.

Running Late

If for any reason you are running late for a session, please notify the therapist scheduled and send an email to your supervising BCBA as soon as possible. If your child is coming to the center for services,please email the therapist, supervising BCBA and the scheduling@behavioroptions.com email. The therapist will wait for up to 15 minutes. Please note your full session may not be met because other clients may be scheduled after your session. This would count as a ‘less than 24-hour fee’ and the full cost of the session may apply.

Schedule Change Requests

To request a general schedule change or to discuss any scheduling concerns, send an email to scheduling@behavioroptions.com. We request that families give us at least two weeks’ notice on significant changes in their plans for in-home ABA sessions scheduling, to facilitate consistency in service delivery.

{Company Name}, LLC Staff member Cancels or Running Late

If your child's session will be canceled or rescheduled by {Company Name}, you will be contacted. If the therapist assigned to the session is running more than 15 minutes late, you will be contacted as soon as possible. The therapist may stay later than scheduled to make up the time missed or make time up on another day. You will only be charged for the time we work with your child. Please notify managers of excessive tardiness. We may need to re-evaluate schedules (re: drive time, traffic, time of day, etc.).

 

Client Handbook Part 10

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Wellness Policy Statement of Understanding

 

Client Handbook Part 11

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Inclement Weather Policies and Procedures

The following statements pertain to the policies and procedures regarding appointments and or travel during inclement weather.
Inclement weather is defined as weather that has the potential to cause injury or harm when traveled in. Examples of inclement weather can take many forms and can include, but should not be limited to the following:

• Unplowed snow covered roads, roads inadequately plowed, or icy roads
• Flash flood warnings, or flooded areas
• A dangerously low chill factor
• Excessively high temperatures, or high heat index
• Poor air quality warnings
• Severe thunderstorm warnings, tornado warnings, or sightings for a related area.

Decisions regarding the weather and/or safety risks shall be made by the {Company Name}, LLC staff from the agency's standpoint. However, the client has the right to reschedule appointments if there is a reasonable risk to safety as opposed to an attempt to merely cancel the appointment. If the staff believes that the weather presents a reasonable risk to the health and safety of the client or staff, any scheduled appointments, to include home visits, planned trips, etc., shall be rescheduled. In the event of a need to reschedule an appointment, the staff shall notify the client as soon as possible by means outlined between the staff and client during the initial stages of the case (phone/email). It should be the understanding of the client that inclement weather and the dangers presented as a result of it can, and will, include areas that lead to the client's home or location of the planned trip. Safe conditions at the client's place, residence, or at the location of the planned trip does not exclude the dangers present in the areas that must be traveled in order to reach these destinations.
Parents acknowledge that it is their responsibility to provide viable contact information, which would include a method of contacting the client in the event of an emergency type situation.

In most circumstances,{Company Name} , LLC staff will follow the county school cancellations for the county in which you or the staff resides. If the staff believes they are able to continue with the scheduled appointment, they will notify you to confirm the session. Sessions are difficult to reschedule given the times families are available, however the staff will make all efforts to make accommodations. Please keep in mind that other regular scheduled appointments may interfere with rescheduling on another day.

Client Handbook Part 12

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Parent Participation

Parents are integral to the success of each child.{Company Name} strives to include parents in all aspects of therapy from goal and objective development to treatment strategies and behavior management skills. The consistency of programming across settings is our ultimate goal. The {Company Name} team members are available to train parents in the areas of behavior management and the application of intensive teaching procedures in the hopes that parents will also become part of the child’s therapy team.
The level, intensity, and frequency of parent training will be included in your child’s Individualized Treatment Plan (ITP).

• To ensure effective implementation of the treatment plan/programming, {Company Name} requests the following commitments listed below and will attempt to correct an issue, otherwise the service plan may be terminated.
• Active participation in training regarding the child’s programming and behavior reduction protocols.
• Adherence to the child’s treatment plan and behavior reduction protocols.
• Immediate communication via email or phone (if necessary) with the Director, team, and parent if unsure about how to implement a program/protocols.
• Immediate communication via email (phone if necessary) with Director from the parent if there is a concern that a program/protocol is not being implemented correctly or working effectively.

Client Handbook Part 13

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Procedure for Lack of Participation

The following is an explanation of the steps that will be taken if a parent/guardian is not participating in their child’s programming.

1. The first time that a parent or guardian does not meet one of the participation requirements, the consultant will provide the parent or guardian with a verbal warning and follow up with an email reminding the parent or guardian of participation requirements. The consultant will explain clearly to the parent or guardian where their participation is lacking. The consultant will offer more training if this is part of the issue.
2. The second time that a parent or guardian does not meet one of the participation requirements, the consultant will provide the parent or guardian with a written notice reminding the parent or guardian of the participation policy. The notice will clearly explain to the parent or guardian where their participation is lacking. The consultant will offer more training if this is part of the issue.
3. The third time that parent or guardian does not meet one of the participation requirements, the consultant will meet with the parent or guardian and provide them a final written notice reminding the parent or guardian of the participation policy. The notice will clearly explain to the parent or guardian where their participation is lacking. The case manager and consultant will work closely with the parent or guardian to provide the training necessary to correct the issue. Additionally, the notice will explain to the parent that if the parent or guardian does not meet the participation requirements again, the child's services will be discontinued.
4. The fourth time that a parent or guardian does not meet one of the participation requirements, the child's services will be discontinued on the grounds that {Company Name} cannot provide effective treatment if the parent or guardian is not participating in the child's programming. The consultant will meet with the parent or guardian to explain to the parent where their participation is lacking. Services will be faded back according to a fade plan that will be individually determined for each child.

The Director and ABA therapy team will work closely with every parent or guardian to ensure that parent participation is as easy and enjoyable as possible for every parent or guardian. When issues do arise, the therapist will work closely with the parent or guardian to determine how to resolve the issue. When parents or guardians participate fully in their child's programming, they should see more progress from their child and have a better understanding of how to respond to various behaviors.

Client Handbook Part 14

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Parents’ Interaction with Staff & Dual Relationships

The nature of our business can often be personal because we are all working so intensely with each other on a frequent basis. For this reason, we mandate that parents maintain a friendly relationship with staff members, but not a personal relationship. Parents acknowledge that any relationship outside the therapeutic one is completely inappropriate.

Dual relationships include, but are not limited to babysitting, acting as a nanny, bartering of services of goods, friendships, sexual relationships, etc. This pertains to past and present employees. {Company Name} strives to hire the best staff; however, at times people may leave our company for various reasons. In this case, we do not encourage families to hire or have dual relationships with our past or present staff members. Due to the confidentiality we hold with our staff members and parents, we cannot go into detail about why a staff member left the company. This is for the protection of {Company Name} and for our clients.

Parents acknowledge that {Company Name} does not ever allow employees to transport clients or client family members.

Client Handbook Part 15

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Agreement to Videotape - Audiotape - Photograph

{Company Name} staff may take photographs or videotapes for marketing, education, or training. Parents acknowledge that they and their child may be photographed or videotaped during a session. Parents give {Company Name} permission to use their image at any point in the future for the purposes of marketing and training. Videos and pictures will ONLY be taken with {Company Name} equipment. {Company Name} Staff are not allowed to record any videos, pictures, or audio using his or her personal equipment. Clients/Parents must receive written permission from {Company Name} before videotaping portions of sessions or taking pictures of {Company Name} staff.

Client Handbook Part 16

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Resolving Grievances

We encourage the client to discuss any matter of concern regarding the services delivered by {Company Name} staff with the BCBA assigned to the case for the purpose of resolving a concern.

Early and immediate resolution of concerns and conflicts is strongly encouraged, and a meeting may be scheduled with the client, staff member, BCBA, and the designated management staff to assist in reaching a satisfactory resolution.

If you feel like the issue/concern has not been resolved, please fill out a formal complaint at Client Complaint Form.

Within two (5) business days of receipt of a written complaint (Via email, letter or the Client Complaint Form), the Director of Operations will respond.

In the event there is not a satisfactory resolution reached with the Director of Operations, the client may appeal the matter to the Director of Clinical Services.

Within five (25) business days of an appeal, the Director of Clinical Services will contact the Client with the final resolution. If the client is still not satisfied, they have the right to refuse services, contact their insurance company/case manager (if applicable), or contact local, state, or federal government agencies.

Client Handbook Part 17

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Permission for Assessment

I give my permission for my child, to be evaluated and/or assessed by Innovative Behavior Options, LLC to determine initial and/or continuing eligibility for services. I understand that this information will also be used to identify my child’s strengths and needs in order to provide appropriate intervention services and programming.

Client Handbook Part 18

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Financial Responsibility Agreement

{Company Name} strives to help as many families as possible and excepts many types of funding such as, insurance, state, county, and self funding.

Insurance: {Company Name} will ensure that all pre-authorization, assessment and progress reports are completed and submitted before the due dates to continue ongoing therapy. However, if any claim comes back as uninsurable, you will be billed for the full amount of services after 60 days.At that time it will be the parent/caregiver responsibility to follow up with insurance for reimbursement. {Company Name}, LLC will give all necessary paper work to the parent or caregiver as they request. Insurance reimbursement is a contract between you, your employer and your insurance carrier. You are responsible for any charges, or portions of charges that your insurance does not pay.
Innovative Behavior Options, LLC is in network with the following insurance companies:

BCBS
Humana
Beacon
UBH/Optum
Aetna

Self Funded:{Company Name} and the parent/caregiver will request a number of ABA therapy hours per week and supervision per month (One hour of Supervision for every 10 hours of ABA therapy provided).

The parent/caregiver will be billed monthly, payment is due on receipt of invoice. If payment is not received within thirty (30) business day of receipt, {Company Name}, LLC has the right to place the account on hold and stop services until payment has been received in full. {Company Name}, LLC will also charge a late payment fee of 60.00 for every late payment.
* We maintain an up-to-date Fee schedule on your online account. Parents are given at least 60 days notice of any fee changes.

The terms of this agreement will continue until either party provides written notice of termination request. Termination will take place 30 days from the date of the request, and termination reports (a minimum of 4 hours billed at the BCBA/BCaBA rate) will be provided at the time of termination. If a notice of termination is not provided in writing, one week of service will be billed to the parents

Invoices:
It is our policy to invoice families for services monthly. We provide an itemized bill with each different service for each different day of service listed. Invoices are sent electronically. Paper copies are available upon request. To request paper copy send an email to billing@behavioroptions.com.The parents/guardians of the child receiving services remain completely responsible for the payment in full of all services related to fees by the due date as stated on the invoice. We accept payment via check, money order, or credit cards (Visa, MasterCard, Discover, or American Express). It is recommended clients use their banks online bill pay as this tends to be the easiest form of payment.

Fees:

• There is a $40.00 Returned Check Fee for all checks returned by the bank.
• Appointments must be canceled at least 24 hours in advance. If they are not canceled with 24 hours’ notice, you will be charged a $60.00 missed appointment fee.
• There is a late Payment charge of $60.00 as described above.

Client Handbook Part 19

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ABA Therapy Service Agreement

Agreement :
During the term of this agreement, {Company Name} will provide ABA Therapy services, and the parents/guardians will compensate {Company Name} a payment for the services as described below in the terms and conditions specified. I understand all the fees and conditions as stated above.

IF IT BECOMES NECESSARY FOR THIRD PARTY COLLECTION, I AGREE TO PAY FOR ALL COSTS AND EXPENSES INCLUDING REASONABLE ATTORNEY FEES.

Services

During the terms of this agreement {Company Name} shall provide the following services:

• Behavioral treatment services, which may include, but are not limited to: direct one-on-one instruction, a continuation of assessments, and modification of programs (data review), completion of Functional Behavior Analysis (FBA) or Functional Behavior Analysis for problem behaviors, an update of Behavior Intervention Plan (BIP), and parent training.
• Other professional services can be requested but are not included in this service agreement may include, but are not limited to:
  • Program development
  • Attendance to meetings or consultations with other professionals you have authorized
  • Preparation of records or treatment summaries
  • Time required to perform any other service which you may request

I agree to the terms of the above agreement:

Client Handbook Part 20

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Nonviolent Physical Crisis Intervention Release

{Company Name} utilizes Nonviolent Crisis Intervention provided by Crisis Prevention Institute as a crisis management system. All staff that may be involved in physical intervention are trained and certified in Nonviolent Crisis Intervention. Please be aware that parents cannot be trained by our staff in personal safety techniques and physical interventions (i.e., restraints).

Nonviolent Crisis Intervention's philosophy is Care (showing compassion and empathy); Welfare (supporting emotional and physical well-being); Safety (preventing danger, risk, and injury); and Security (ensuring harmony-not harm). The focus of Nonviolent Crisis Intervention is on the client and emphasizes the importance of being supportive and maintaining therapeutic rapport. The staff has been trained to understand the levels of crisis development, how each level of crisis should be approached, and how to proactively prevent any need to use physical intervention by teaching replacement behaviors.

Nonviolent physical crisis intervention is the safe, non-harmful control and restraint positions to safely assist an individual until he/she can regain control of their behavior. Physical management will only be utilized as a last resort when all other less restrictive strategies have been exhausted, or when a person is considered a danger to self or others, according to the procedures provided by QBS Safety-Care per policies established by {Company Name},LLC.A serious incident will be documented in a written report and reviewed with the parent/guardian/ witnesses. The report will be submitted to the Director of Operations and placed in the client's file.

When addressing problem behaviors, client's care, welfare, safety, and security will be our primary focus. Nonviolent Physical Crisis intervention will always be a measure only used to ensure the safety of clients and others. If you have any questions or concerns regarding this policy, please contact {Company Name},LLC at any time.

If you choose to decline the use of physical intervention, it will be assessed by the {Company Name}, LLC staff including, at minimum, the executive director, supervisor, and therapist the level of risk in the home and if services can continue to be provided safely without the use of physical intervention.

Client Contact Information

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Parent Questionnaire Part 1

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Please answer each question below. There are no right or wrong answers.

Parent Questionnaire Part 2

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Medical Questionnaire Part 1

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Medical Questionnaire Part 2

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Medical Questionnaire Part 3

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Medical Questionnaire Part 4

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Family History: Please check if your child’s parents, grandparents, aunts/uncles, siblings, or cousins have/had any of the following (indicate which family member):