Notice of Privacy Practices
Effective date: May 1, 2003
Revised: February 2, 2015
THIS NOTICE DESCRIBES HOW CONFIDENTIAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact, Francine Togneri, Psy.D, LCSW, Behavioral Health Services Director, or Leeann Ekstrom, MFT, Behavioral Health Services Quality Improvement & Compliance Administrator at (562) 490-7600. Correspondence in writing may be sent to 5150 E Pacific Coast Hwy, Suite 100, Long Beach CA 90804.
OUR DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI) ALSO KNOWN TO CHILDNET AS CLIENT CONFIDENTIAL INFORMATION (CCI)
We understand that identifiable information about you and/or your family is personal. We are committed to protecting your private and confidential information. All information, whether it is past, present, or future treatment services and/or payment information is considered client confidential information (CCI). As a result we have developed this notice referred to as ChildNet’s “Notice of Privacy Practices.” By law we are required to extend certain protections to your CCI. This Notice of Privacy Practices explains in general terms how, when and why we may use or disclose your CCI. We also describe your rights and certain obligations that we have regarding the use and disclosure of your CCI. We will follow the practices described in this Notice, though we reserve the right to change our privacy practices and the terms of the Notice at any time. If we do so, we will post a new Notice on our website and at our physical locations (see addresses to the specified ChildNet locations at the end of this notice).
WHO WILL FOLLOW THIS NOTICE
This notice describes our agency’s practices and that of:
- All ChildNet departments under the Behavioral Health Services (BHS).
- All ChildNet employees and volunteers who may have contact with you and/or who deal directly with your CCI in regards to payment, treatment and overall Agency operations.
HOW WE MAY USE AND DISCLOSE YOUR CCI
The following categories describe various ways that we use and disclose confidential information. For each category of use or disclosure, we will explain what we mean and give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the following categories.
We may use your CCI to provide you with appropriate mental health treatment, psychiatric services, case management services, Wraparound and TBS (Therapeutic Behavioral Services) when indicated. ChildNet uses teams and takes an inter-disciplinary approach when providing services. Your CCI will be shared among members of your treatment team and/or any individuals involved in the coordination of your care. Therefore, a psychiatrist, therapist, case manager and administrative staff member, etc., will need to know your CCI when all are responsible for some aspect of your treatment. For example, if you are receiving psychiatric and mental health services, your therapist and psychiatrist will need to discuss your treatment in order to provide you with the best possible care.
We may use and disclose CCI about you so that the services you receive may be billed and collected by ChildNet. Information may be sent to a third party, such as MediCal, Los Angeles County Probation, Department of Children and Family Services (DCFS), Department of Mental Health (DMH), and other County or State organizations, in order to collect payment for services. Therefore, office support staff and appointed accounting staff members may disclose your CCI. In addition, your CCI may be shared with County or State agencies in order to determine your eligibility for publicly funded services. For example, your diagnosis will be given to MediCal to verify payment for treatment services and medication support services when necessary.
FOR OVERALL OPERATIONS
We may use or disclose your CCI for overall operations. These uses and disclosures are necessary to ensure that all clients receive quality services. For example, CCI may be shared in order to review and evaluate the performance of our staff providing care to ChildNet clients. We may disclose information to staff members for review and learning purposes.
OTHER SPECIFIC TREATMENT, PAYMENT AND OPERATION EXAMPLES ARE AS FOLLOWS:
STAFF SUPERVISION AND TRAINING
We may use or disclose your CCI for supervision and training purposes. These situations occur in all program areas in order to ensure that ChildNet employees receive the necessary training and supervision. For instance, a ChildNet therapist may discuss your CCI with a licensed ChildNet professional in order to review treatment interventions, progress, areas of concern, etc. There may be therapy sessions that are video and/or audio taped as well as live supervision sessions for the purposes of training therapists on various treatment issues and interventions. Many therapists at BHS are unlicensed Clinical Interns and their work is supervised by a Licensed Clinical Supervisor. Your assigned therapist may be a Clinical Intern.
AGENCY QUALITY ASSURANCE AUDITS AND PROGRAM REVIEWS
Many of the ChildNet programs are accountable to State and County agencies in order to maintain licenses, registrations, certifications, etc. As a result, these agencies may conduct investigations, audits, inspections, etc., where your CCI may be disclosed. For example, DMH reviews BHS treatment files in order to ensure that the services provided to you are suitable and necessary. These activities are necessary in order for the government agencies to monitor our overall operations and to ensure that ChildNet is in compliance with required standards, laws and regulations. ChildNet also conducts internal audits where treatment files are reviewed on a regular basis.
APPOINTMENT REMINDERS & TRANSPORTATION SERVICES
We may disclose your CCI in order to contact you as a reminder that you have an appointment. For example, ChildNet sometimes provides transportation services and the ChildNet van driver will be provided your telephone number and address.
REFERRAL AND RESOURCES
ChildNet is committed to ensuring that all clients receive the best quality care and, therefore, referrals to outside resources are often necessary. For instance, many clients ask that ChildNet staff members act as their advocate. For example, case managers frequently assist clients and their families by calling various agencies regarding housing, as well as programs that will assist with legal, medical, and family issues, etc.
ChildNet is always interested in how treatment services can be improved and at times will mail satisfaction surveys to current and previous clients. The data is collected and analyzed by ChildNet staff. BHS conducts yearly surveys in which BHS Administration reviews the responses to the survey questions.
ChildNet may use your CCI in order to contact you for fundraising purposes. We may contact you and inquire if you are interested in speaking at a fundraising event and discuss your experiences with ChildNet.
As Required by Law
An interdisciplinary team approach forms the basis of the ChildNet philosophy. Therefore, issues discussed, during a therapy session for example, will likely be made available to all treatment members serving your best treatment interests. However, it is required by law that ChildNet employees obtain an authorization signed by you in order to use or disclose any CCI otherwise described in this notice. Lastly, State and Federal law mandates that treatment ChildNet employees report to the proper authorities’ information related to the following:
- Reasonable suspicion of sexual abuse, physical abuse, and neglect of children (under the age of 18).
- Reasonable suspicion of an imminent danger to self (suicidality).
- Reasonable suspicion of an imminent danger to others (Tarasoff).
- Reasonable suspicion of the abuse of elderly persons or dependent adults.
- Legal Disputes/Subpoenas
OTHER POTENTIAL USES OF MEDICAL INFORMATION
If requests for CCI are not covered by this Notice, we will ask for your written authorization before using or disclosing your CCI. Specific examples requiring your authorization include:
- Psychotherapy progress notes. Progress notes of treatment sessions are kept separately in the client chart/medical record and are not released.
- With very limited exceptions, most uses and disclosures of CCI for marketing purposes;
- Any disclosures that would constitute the sale of your CCI.
YOUR RIGHTS REGARDING YOUR CCI
Right to Inspect and Copy – You have a right to inspect and copy some of your CCI. We will accommodate your reasonable requests to release your health information by alternate means or at alternate locations. Some limitations apply when we believe that releasing the information may cause harm to you or others.
Right to Amend – If you feel that your CCI is incorrect or incomplete, you have the right to amend the information. However, we are not obligated to make the correction if we disagree with the amendment. For example, if we are not the originator of the record or a portion of the record, or we believe the change being requested to be inaccurate, we will decline to make the change. You have the right to submit a letter of addendum explaining your challenge of the record. That letter will accompany your record whenever we make an authorized disclosure.
Right to an Accounting of Disclosures – You have a right to request an “accounting of disclosures.” This is a list of the disclosures we made of CCI other than for our own uses for treatment, payment, and overall ChildNet operations, as those functions are described herein.
Right to Request Restrictions – You have the right to request restrictions or limitations on the CCI we use or disclose. You also have the right to request limits on the CCI we disclose to someone who is involved in your care or for the payment of your care. However, we are not required to agree to your request for limitations or restrictions except when you pay 100% out-of-pocket for services. When you are 100% financially responsible for services, we are obligated to agree to your request for restriction. If we do agree to the restriction of your record as requested, we will not disclose your CCI unless the information is needed to provide you with emergency treatment. In addition, we will disclose CCI if required by law. For example, we will disclose your CCI if the information requested is from the Secretary of Health and Human Services or the Office of Civil Rights. It is your responsibility to notify any other providers or business associates about your restrictions, i.e., doctors, pharmacies, etc. ChildNet will notify you if we are unable to agree to your requested CCI restrictions.
Right to Revoke Authorization
You can revoke your CCI authorization by notifying us in writing of your decision, except under the following conditions: 1) we have disclosed CCI based on your prior authorization; 2) we are obligated to disclose your CCI under law to collect payment or other perpetually authorized events.
Right to Notice of Breach
You have a right to be notified in the event that ChildNet believes your CCI has been breached.
Right to a Paper copy of this Notice – You have the right to a paper copy of this notice and may request a copy at any time.
Please note that you MUST submit all requests regarding your above mentioned “Rights” in writing to the ChildNet Privacy Officer. If you submit a request, we will respond and provide you with the details regarding each Right within 30 days.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for CCI we already have about you as well as any information we receive in the future. We will post all new and revised Notice of Privacy at all ChildNet sites and the website. We will ask that you acknowledge that you received a copy of this notice at the time of your admission to ChildNet.
If you believe your privacy has been violated, you may file a complaint with the agency. Please contact the ChildNet Privacy Officer and note that all complaints must be in writing.
Correspondence with ChildNet’s Privacy Officer:
By phone (562) 490-7600
In writing may be sent to:
5150 E Pacific Coast Hwy, Suite 100
Long Beach CA 90804.
You may also file a complaint with:
Office Civil Rights
U.S. Department of Health and Human Services,
200 Independence Avenue, S. W.
Washington, DC 20201
Filing a complaint will not negatively affect the treatment or coverage that you receive and you will not be penalized in any way.
LOCATIONS – ChildNet Youth and Family Services
Behavioral Health Services & Wraparound Services
5150 E Pacific Coast Hwy, Suite 100
Long Beach, CA 90804
(562) 490-7600 or (562) 961-6300