Thank you for considering Latina Griffin, LCSW, for your mental health needs. I am a Licensed Clinical Social Worker (Texas license #60442).
My private practice focuses on adults and adolescents. During your therapy I use therapeutic frameworks such as Cognitive Behavioral, Emotionally Focused, and Trauma Informed therapy.
Clients who willingly and actively participate in the therapeutic process experience improvement in their situations in almost all cases. However, please be aware that results may vary. Treatment is intended to induce change in your life, and when this change occurs it may disrupt your accustomed manner of living and your relationships with others. Positive change takes work, and you may be asked to try things that are difficult for you. Some people reach their goals fairly quickly and without much discomfort, while others need more time and feel more stress through the process. The experience of each individual is impossible to predict as each person has their own unique strengths, struggles and concerns. If I determine a change in the nature of services will be beneficial to your treatment, I will consult with and inform you about this change.
My office hours vary and I am often not immediately available by telephone. I routinely return calls within 24 hours during regular business hours, Monday through Friday, 9:00 a.m. to 5:00 p.m. When leaving a message, please share the best times to reach you.
You may schedule an appointment by phone: (737) 808-4179, or email: email@example.com.
The frequency of appointments and the length of service will vary depending on your needs.
Appointments are 50 minutes in duration, and the time scheduled for your appointment is assigned to you and you alone. You are responsible for coming to your session on time. If you are late, your appointment will still conclude at the scheduled end time.
Except in the case of an emergency, 24-hour notice is required to reschedule or cancel an appointment. If you fail to provide 24-hour notice, you will be charged $135, the fee for a 50-minute session.
My office is not an emergency facility, and I do not provide 24-hour crisis or emergency therapy services. Should you experience an emergency necessitating immediate mental health attention, immediately call 911. Or, if you are able to safely transport yourself, go to the nearest hospital emergency room for assistance.
If you are suicidal, you can call the National Suicide Prevention Hotline at (800) 273-8255. If you have insurance you can call the number listed on the back of your card and get a referral to an in-network psychiatric hospital for consultation with an intake specialist.
If, in my judgement, you appear too impaired to safely transport yourself after a session, I will call your emergency contact to transport you home. In the event of a medical emergency, I will call your emergency contact after calling 911.
The fee for each 50-minute session is $135.00 for individuals and $150.00 for couples, due at the time of service. I accept cash, check, HSA cards, or credit card. I will provide a receipt, which you may submit to your insurance company or healthcare savings account to request reimbursement for services as an out-of-network provider. I do not accept insurance and cannot guarantee reimbursement.
I may charge my standard $135 hourly fee for other professional services needed, although I will prorate the hourly cost if I work for periods of less than one hour. Other services may include report writing, telephone conversations lasting longer than 10 minutes, attendance at meetings with other professionals you have authorized, preparation of records or treatment summaries, and the time spent performing any other service you may request of me. You are expected to pay for services at the time they are rendered unless other arrangements have been made. Please notify me ahead of time if any problem arises regarding your ability to make timely payment.
If you have an HSA account, I can provide you with a monthly invoice summarizing your payments, which you can submit for reimbursement.
There will be a $15 “insufficient funds” charge for each returned check.
A credit card will be collected at the time of the first appointment.
Phone calls lasting more than 10 minutes will be billed at the session rate, prorated to $2.50 per minute.
Treatment is entirely voluntary, and you have the right to terminate treatment at any time. While I hope that any termination will be discussed and agreed upon, I have the right to terminate therapy with you under the following conditions:
· Therapy is no longer appears to be beneficial to you.
· You fail to abide by stated office policies.
· You refuse to participate in the therapeutic process.
· I believe that you will be better-served by another professional.
· Outstanding balance for two unpaid sessions, unless special arrangements have been made.
· You failed to attend your last two therapy sessions without a 24-hour notice.
· More than 30 days have passed since your last therapy session and you have not rescheduled another session.
Interactions Outside the Office
If we happen to encounter each other outside of the professional setting I will not address you unless you address me first to protect your privacy. I will return a friendly greeting and allow you to initiate a brief interaction. I will not discuss any therapy related information.
If you are seeking services at the request of a third party, who may also be paying for your therapy, our therapy relationship will remain confidential according to the terms of this document.
Services for Multiple Parties
If you are seeking therapy sessions for more than one person (i.e. family, spouses, couples) I am required to honor confidentiality between each person. Please understand that I can only represent all parties if it remains in everyone’s best interest for me to do so. If, in the course of therapy, a conflict of interest does arise where I am no longer able to serve the best interests of all parties, I will be required to withdraw from all professional services for each party.
Plan for Practice in case of Death or Disability
In the event of my death, incapacity or disability, I have made arrangements for another psychotherapist to take over my practice, assume control of my records, meet with clients, make appropriate referrals to other providers, if necessary, and take all reasonable steps to manage the practice for the benefit of my clients. Your signature below, you authorize my designee to contact you directly, and use and disclose your confidential mental health information and records for the stated purposes.
Policies Regarding the Treatment of Minor Children
As a parent, your participation in your minor child’s counseling is important for long-term gains. The extent of your involvement will be determined during the first sessions. You may need to learn a different way of dealing with your child to facilitate and maintain gains. I may ask to meet with parents or caregivers before meeting with your child, and I will ask for your feedback and views on your child’s therapy, progress and other aspects of the therapy and expect you to respond openly and honestly.
While minors do not have the same legal right to privacy as those 18 and over, I ask that you allow the discussion in the therapy office to be confidential. When possible, I work with your minor child to determine the best way to share important information with you to avoid damaging trust in the therapeutic relationship.
You affirm that you are the parent or legal guardian of the child and you have the legal right to consent to psychological treatment for the child, and that there has not been a Divorce Decree or any other Court Order that limits your ability to consent to the child’s treatment. If the child’s parents are divorced or never married, BOTH parents must consent to treatment, in compliance with any Divorce Decree or Court Order that may be in place. I also require a copy of the Divorce Decree or Court Order prior to providing any services to the child, and you agree to provide it immediately upon request. If the parents of the minor client have remarried or have significant others who may be involved in the child’s therapy, I will meet with all involved adults before seeing the child, to obtain signed Authorizations for the limited sharing of information regarding the child, and to establish the boundaries for my treatment of the child.
Adults should not ask to speak with me before the child’s appointment in front of the child. If you have information to share, please do it privately unless we have agreed otherwise. Also, I do not allow step-parents to access the child’s records or make therapy appointments for child clients unless the child’s parents have signed an Authorization allowing the step-parent access to the child’s records or allowing the step-parent to schedule the child’s appointments.
If I believe that the child is in danger or is a danger to someone else, I will notify the parents of my concerns. If a parent would like feedback as to how the sessions are progressing, parents are invited to participate in the last 5-10 minutes of the session, with the minor client present. Parents are welcome to contact the me by telephone, subject to my telephone consultation policy.
Use of Electronic Communications
You will receive text messages reminding you of your scheduled appointment. You may send a text message if you need to cancel or reschedule your appointment. Text messages are NOT to be used to communicate clinical issues. If you need to discuss a clinical issue between scheduled appointments, please schedule a phone consultation.
You may email necessary information such as needed documentation. I will reply only to confirm receipt. I will not comment electronically on any of the content.
Clients may use only the published practice email and phone numbers. My personal contact information may not be used by clients to contact me.
If electronic-use policies regarding text and email communications are not respected, I will take steps to block further e-mails and texts. I also reserve the right to terminate therapy and refer you to other providers.
I do not allow audiotaping of sessions unless we have agreed otherwise in advance and you have signed a specific written authorization for the taping to occur. For this reason, I request that you turn your phone off when you enter my office. I reserve the right to confirm that your telephone is off, or request that you leave your telephone in your car.
I do not accept “friend” requests from current or former clients on my psychotherapy-related profiles on social networking sites because these sites can compromise clients' confidentiality and privacy. For the same reason, I request that clients do not communicate with me via any interactive or social networking websites.
I will never post information about a client on a public website. I ask that you respect my privacy and refrain from posting reviews or other information regarding me or my practice on any website such as Angie’s List, Yelp or other forum for posting public reviews of health care providers without my prior written permission.
In general, the privacy of all communications between you and a therapist is protected by law, and I can only release information about our work to others outside your relationship with your written permission. I am required by law to honor my practice’s Privacy Practices as provided to you in a separate document.
I will not use your health information for marketing, development, publications, etc. or any related activities without your written authorization. I cannot disclose your information in any way other than those described in this notice unless you give me written authorization to do so. You may revoke this authorization at any time.
Please refer to my Privacy Practices for detailed information regarding when your healthcare information may be disclosed to third parties.
To ensure best practice in my therapeutic work, I participate in consultation with other mental health professionals. Client identifying information is rarely used and limited only to what is necessary for the understanding of those in the small consultation group.
Professional Records Documentation
Documentation of sessions consists of a summary of each meeting and may include general issues addressed, possible symptom presentation or change, level of functioning, mental status, diagnosis and treatment plans. State and federal law require that I maintain appropriate treatment records for at least 7 years from the last date of service. If the client is a minor child, I must maintain treatment records for 7 years from the date the child turns 18.
I can release all or portions of your records to any person or entity you specify. Any request for records must be in writing. Please be advised that a consent for disclosure and records request must be completed before I can release any information.
If you request a copy of your records, I will provide them to you within 15 days of receiving the request unless I believe that doing so would endanger your life or the life of another person. If I believe that I must withhold the records due to a life endangerment, I will write you a letter to explain my reasons for withholding the records and your options.
The fee for providing you with a copy of your records will be $25.00 for the first 20 pages, and $ .50 cents per page thereafter, plus the actual cost of shipping or mailing. I am not required to provide copies of requested records until the fee is paid.
You have a right to have your complaints heard and resolved in a timely manner. If we cannot work things out to your satisfaction you may contact my licensing board: Texas State Board of Social Worker Examiners, Complaint Management and Investigative Section, P. O. Box 141369, Austin, Texas 78714-1369, (800) 942-5540.