Stepping Forward Counseling and Consulting, LLC
Stepping Forward Counseling and Consulting, LLC
Professional Disclosure/Consent for Treatment Contract
Please Read Carefully
Stepping Forward Counseling and Consulting, LLC is located at 458 Old Cherokee Road, Suite 204, Lexington, SC 29072. Our mailing address is PO Box 85742, Lexington, SC 29073. Typical office hours are Mon-Thurs 8:30am-7pm. All appointments are made based on the individual counselor’s availability and the unique scheduling and treatment needs of each client. The confidential office number is (803) 727-2978 and is used to schedule appointments, contact your counselor, and for emergencies. Communications are returned as quickly as possible, typically within 2 business days. Further information about phone calls, texting, and email communications are below.
Kelly J Weaver is the director/counselor of Stepping Forward. She is a Licensed Professional Counselor and a Licensed Professional Counselor Supervisor. She received her Bachelor of Science in Psychology (High Honors, Cum Laude) from Wofford College. She has her Masters of Education in School Psychology and an Educational Specialist Degree in School Psychology/Community Agency Counseling from James Madison University. Kelly provides on-site supervision for graduate students and professional counselor interns. The counselors of Stepping Forwardprovide services for individuals (children, teens, and adults), couples, and families. They are also able to consult with families, schools, and other health providers. See the website for all current center counselors and their professional qualifications and specialties.
Stepping Forward accepts most insurance companies and many EAPs (Employee Assistance.) Insurance companies often place confusing restrictions on mental health services. We will make every effort to work with you and the company. However, you are expected to know your benefits prior to the first appointment. If you have not or do not know whether your deductible has been met, you will be charged the full fee, with refunds minus co-pay or a credit being made upon confirmation about the deductible. Elite Medical Billing will provide all billing and insurance filing services. They will handle any concerns about your account and theymay contact you to inquire or collect on any balances due. We may also send postal mail, including bills, to the address you provide. Further information about billing practices are explained below:
Fees for services are expected and will be processed per agreement at the time they are provided.
*Credit/Debit/HSA cards are accepted. As of January 1, 2016, it is the standard practice of Stepping Forward to securely store client credit/debit/HSA card information within the encrypted system of ePN processing company. You will find the consent forms explaining this further in the Intake Form section of this website.
*A 20% discount is given for cash/check payments. Checks should be made payable to:Stepping Forward. *An alternative fee/payment schedule may be available; please contact your counselor.
Standard services fees are as follows:
$100/hrPer 45-60 minute Individual, Marital, Family, and Co-therapy session
$100/hrPer 45-60 minute off site meeting, at client request.
$30For phone calls lasting more than 15-minutes < 30-minutes
$50/hrFor written documents requested by clients including but not limited to summative, letters, affidavits, etc. Time spent will be prorated.
$50/hrFor consultation services (including phone calls, and staffing with other professionals (lawyers, DSS workers, GALs, etc) Time spent will be prorated.
$70For any late cancellation (those without 24-hour notice, or over a weekend) or for notshowing up. Payment will immediately be processed per agreement.
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Fees for legal involvement are as follows:
While Stepping Forward counselors do not accept clients who desire testimony in court, we will comply with court orders. Please let your counselor know a week in advance if you require any of these services.
$1/pageFor each page of record copying requested. No records will be released without signed client consent. Per HIPPA, clinician notes are confidential and will not be released. Only minimum standard records will be shared.
$300 minimumFor any court preparation, which is necessary upon receiving a subpoena (including phone calls, record review, legal consultation, copying, travel, etc) Payment must be made up front.
$800/dayFor each day of availability for court testimony. The entire day must be set aside, thus 8 hours at $100 per hour. In addition, travel expenses at 44.5 cents per mile. Payment is requested up front.
Confidentialityis of the utmost importance in counseling. Your records and the information you share is protected health information and is considered confidential by both SC and federal regulations. Your file can be subpoenaed through SC court order signed by a judge, but is considered privileged in the federal court system. Stepping Forward is mandated by Duty to Warn standards to breach confidentiality in cases of (1) threats of self-harm or suicide, (2) threats to harm another or homicide, (3) a child has been or is being abused or neglected, and/or (4) a vulnerable adult has been or is being abused or neglected. Any release of your confidential file requires your written consent.
Ethical Behaviorby your counselor should be expected at all times. All counselors with Stepping Forward follow (1) the Code of Ethics for the SC Board of Examiners for the Licensure of Professional Counselors, Marriage and Family Therapists, and Psycho-Educational Specialists, (2) the American Association of Christian Counselors, and (3) the Board of Christian Professional and Pastoral Counselors. Any type of sexual behavior between counselor and client is unethical. Any breach of ethical standards should be reported to the board. The Board of Examiners contact information is posted in the counseling office.
Termination of Counseling: Each Stepping Forward counselor will work with you to create a timeline for the counseling process. Either party may choose to end at any time. A Stepping Forward counselor may end counseling earlier than proposed and refer you to another professional if you become uninterested/uninvested in counseling, repeatedly miss appointments, disregard this service contract, or fail to pay your bills. All counseling files will be considered Inactive after 3 months of no appointments. Most counseling sessions can be Reactivated by calling your counselor.
Consent for Special Circumstances:
Children and Adolescents Age 15 and Under
At this age, child clients are considered dependents and confidentiality ultimately belongs to the legal parent. However, your child’s privacy will be maintained. The counselor will decide the timing of involving parents directly in the sessions to address issues such as safety concerns, family dynamics, the healing process, etc.
Children of Separated or Divorced Parents/Guardian Parents/Supportive Adult
These situations can be difficult and delicate. Consent for treatment must be given by the legal parent/guardian, and preferably by both parents in a joint custody. Unless there is sole custody, both parents have the right to communicate with me regarding the well-being of their child. Stepping Forwardhas the right to communicate with either parent based on professional judgment for the welfare of the child. Because the child is the client, the counselor will advocate for them and will not engage in marital conflict or legal disputes, only co- parenting issues.
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Teenagers Age 16-18 years old and some College Students
At these ages in SC, confidentiality belongs to the client. The counselor is aware, that in most cases, teens are still legally dependent, living at home, with parents paying for services. There must still be written consent of the client to communicate with parents. It is general practice to work with adolescent parents, while maintaining client privacy. The potential dangerousness of a teen’s behavior is a clinical judgment and in circumstances where they are not cooperative with intervention, it may be necessary to more fully involve the parent or end counseling. It should be noted that information received from the parent is not confidential and will not generally be kept secret. Counseling information should not be subpoenaed.
Couples Counseling
The purpose of couples counseling is for reconciliation and healing, and is in conflict of legal action, which is adversarial. No information about couples counseling will be released without both parties written consent, because the relationship is the client. It is in the best interest of the counseling process that both parties agree not to subpoena the counselor for either side’s pursuit of a divorce or custody trial. In addition, information received from either party will not generally be secret or confidential.
Family Counseling
As with couples counseling, the purpose of family counseling is healing and reconciliation. In family counseling, the family is the client. Thus, no information will be released without the written consent of all members. It is in the best interest of the counseling process that everyone agrees not to subpoena the counselor in pursuit of a legal action. Information received from any member of the family will not be considered confidential or necessarily be kept secret.
Phone Calls: Being a small counseling center, phone calls will be managed by your counselor through a confidential voicemail, with calls being returned as soon as possible, typically within 2 business days. The phone number you receive can be used for scheduling appointments, cancelling appointments, reaching your counselor, and for emergencies. Phone conversations are not counseling. Any call lasting more than 15min will be charged.
Texting/Email Correspondence: Texting and email are convenient ways of communicating non-urgent questions, requests and messages. Your confidentiality could be compromised if you share your email with someone else, if it is a work email, or your service provider reviews your correspondences or gets hacked. Emailing is not counseling. Stepping Forward requests that texting and email communications be used for appointment requests/cancellations/rescheduling/and reminders. It would also be appropriate for requesting a school/work excuse or clarification of a homework assignment. Note: All emails will be copied and put in client files.
Supervision and Consultation: Professional Ethical Standards require ongoing peer supervision of a counselor’s clinical practice. These periodic consultation sessions address clinical, legal, and professional issues. These consults are held in the strictest of confidence with no client identifiable information being shared. Further, Kelly J Weaver is a S.C. LPC Supervisor and will regularly staff cases with students and counselors seeking additional licensure. These supervisees may ask to sit in on various counseling sessions to observe, hone processing skills, and gain exposure to working with diverse populations.
Additional Information about Counseling
It is important to understand the counseling process. If you ever have any questions or concerns, it is imperative that you talk about them. Your signature below shows that you have been informed and understand each point.
* Counseling and therapy are unique forms of health care. The goals of counseling are to help you better understand yourself and the world around you, to help you solve problems and cope with life situations better, and to become aware of your inner thoughts and feelings.
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* The most common form of counseling is talking: talking about your feelings, your problems or concerns,and your experiences of yourself and your situation. Other techniques specific to your needs will be used, including reading articles or books, written exercises, relaxation techniques, etc.
* The length of counseling will depend on your specific needs and the rate of progress toward the treatment goals you set. We will continually review your progress and satisfaction and will set new goals as needed.
* Counseling is often hard. As you work hard to press forward toward your healing, sometimes it feels worse before feeling better. Your counselor is there to ‘walk beside you’ as you strive for self-awareness, self-esteem and self-confidence. We also want you to feel hopeful through your current situation into your future, to feel understood and acknowledged, and to take an active, responsible part in your own life.
* You always have the right to continue or end counseling. Your present counselor should be helpful in referring you to someone who might better meet your clinical needs. The most common alternatives to a counseling relationship are self-help materials, support groups, biblio-therapy, religious/spiritual counsel, etc. You agree to hold harmless any other counselor within Stepping Forward. Your present counselor has signed alongside you below.
* Sometimes persons or families find themselves involved in legal issues. Counseling is for healing, court proceedings are often about division. Clients are expected not to use or request information given to me during counseling for their own legal purposes or against any of the other participants in a court or judicial setting of any kind, as in a custody battle or divorce proceedings.
Notice of Rights and Privacy (HIPPA-1996)
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. This document may be updated without notice so please review it each time you visit us. A copy of this statement is always available upon request.
All information revealed by you in a counseling or therapy session and most information placed in your counseling/therapy file (all medical records or other individually identifiable health information held or disclosed in any form (electronic, paper, or oral) is considered “protected health information’ by HIPPA. As such, your protected health information cannot be distributed to anyone else without your express informed and voluntary written consent or authorization. The exceptions to this are defined immediately below. Additional information regarding your rights as a client can be found in your therapist’s/counselor’s Professional Disclosure/Consent for Treatment.
Uses or disclosure of the following protected health information does not require your consent or authorization:
1. Uses and disclosures required by law - like files court-ordered by a judge
2. Uses and disclosures about victims of abuse, neglect, or domestic violence - like the Duties to Warn explained in your therapist /counselor’s disclosure statement
3. Uses and disclosures for health and oversight activities - like correcting records or correcting records already disclosed
4. Uses and disclosures for judicial and administrative proceedings - like a case where you are claiming malpractice or breech of ethics
5. Uses and disclosures for law enforcement purposes - like if you intend to harm someone else (see Duties to Warn in your therapist /counselor’s disclosure statement)
6. Uses and disclosures for research purposes - like using client information in research, always maintaining client confidentiality
7. Uses and disclosures to avert a serious threat to health or safety - like calling probate court for a commitment hearing
8. Uses and disclosures for Worker’s Compensation - like the basic information obtained in therapy/counseling as a result of your Worker’s compensation claim
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Your Rights as a Counseling/Therapy Client under HIPPA:
* As a client, you have the right to see your counseling/therapy file. (Psychotherapy notes are afforded special privacy protection under the HIPPA regulations and are excluded from this right.)
* As a client, you have the right to receive a copy of you counseling/therapy file. This file copy will consist of only documents generated by us. You will be charged copying fees at $1/page. (Psychotherapy notes are afforded special privacy protection under the HIPPA regulations and are excluded from this right.)
* As a client, you have the right to request amendments to your counseling/therapy file.
* As a client, you have the right to receive a history of all disclosures of protected health information. You will be charged copying fees at $1/page.
* As a client, you have the right to restrict the use and disclosure of your protected health information for the purpose of treatment, payment, and operations. If you choose to release any protected health information, you will be required to sign a Release of Information form detailing exactly whom and what information you wish disclosed.
*As a client, you have the right to register a complaint with the Secretary of Health and Human Services if you feel your rights, herein explained, have been violated.
Prior to your counseling or therapy, you will [be able to view, print, and/or] receive (1) an exact duplicate of this page and (2) your counselor’s professional disclosure/consent to treat policy - for your personal records. It will be necessary for you to sign a certificate indicating that you have received, read, and understand both documents. This certificate will be placed in your counseling/therapy file. Please do not sign the certificate if you do not understand any part of the HIPPA Client’s Rights or the Professional Disclosure/Consent for Treatment. Your counselor or therapist will be happy to explain these documents further.