Effective date: May 1, 2003

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:

Monica Quinones
ChildNet Youth and Family Services
Vice President Community-Based Services
(562) 490-7664

or

The ChildNet Privacy Officer and Director of Quality Assurance:
Leeann Ekstrom
(562) 997-4441

By Mail:
P.O. Box 4550
Long Beach, CA 90804

OUR DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION KNOWN TO CHILDNET AS CLIENT CONFIDENTIAL INFORMATION (CCI)

We understand that individually identifiable information about you and/or your family is personal. We are committed to protecting this private and confidential information. All information, whether it is past, present, future or payment information, is considered client confidential information (CCI). As a result we have developed this manual called a ¡°Notice of Privacy¡± and by law are required to extend certain protections to your CCI. This Notice of Privacy explains how, when and why we may use or disclose your CCI. We also describe your rights and certain obligations we have regarding the use and disclosure of CCI. We will follow the practices described in this manual, 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 (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 different ways that we use and disclose confidential information. For each category of uses or disclosures we will explain what we mean and try to 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.

For Treatment

We may use your CCI to provide you with proper case management, clinical, psychiatric and treatment services. 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, nurse, clinician, administrative staff members, etc. will need to know your CCI as all are responsible for some aspect of your treatment. For example, your assigned clinician may have to discuss any health issues or treatment goals and progress with your assigned case manager. In addition, your assigned clinician may have to inform your psychiatrist that you are having trouble sleeping in order for the doctor to properly assess the effects of your psychotropic medication.

For Overall Operations

We may use or disclose your CCI for overall operations. These uses and disclosures are necessary to run the agency and make sure all clients receive quality services. For example, CCI may be shared in order to review our treatment and services and to evaluate the performance of our staff in caring for you. We may disclose information to staff members for review and learning purposes.

For Payment

We may use and disclose CCI about you so that the services you receive may be billed and collected by ChildNet. Information, may need to be passed on to a third party, such as MediCal, Los Angeles County Probation and Department of Children and Family Services (DCFS), Department of Mental health (DMH) and other county or state organizations in order to collect payment of 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 you eligibility for publicly funded services. For example, your diagnosis will be given to MediCal to verify payment of therapy and possible medication support services.

Other specific treatment, payment and operation examples are as follows:

Agency Quality Assurance Audits and Program Reviews
Many of the ChildNet programs are accountable to state and county agencies, in order to maintain licenses, certifications, etc. As a result, these agencies may conduct investigations, audits, inspections, etc. and your CCI may be disclosed. For example, DMH will review BHS treatment files in order to ensure that the therapy provided to you is suitable regarding the diagnosis documented. 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 does have transportation services and the ChildNet employee, the van driver, may be provided your telephone number and address.


Referral and Resources

ChildNet is committed to ensure that all clients receive the best quality of care and therefore referrals to outside recourses are often necessary. For instance, many clients ask that ChildNet staff members (case managers) act as their advocate and request the staff call various agencies regarding housing, legal, medical, family issues, etc.

Directories or Identification Cards

It is crucial in some ChildNet programs, that daily activities are structured on a consistent basis. As a result, client names are posted in order to maintain organization. The ChildNet vans also regularly carry a copy of client medical cards for emergency purposes, therefore CCI may be disclosed in order to ensure safety as a priority.

Staff Supervision and/or 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 or group sessions that are video taped for the purposes of training staff members on various treatment issues and interventions.

Research

ChildNet is always interested in how treatment services can be improved and at times will mail satisfaction surveys to previous clients. All of the data is collected and analyzed by ChildNet employees.

Fundraising Activities

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. Communication between the employees in different programs regarding services provided to you and other clients is essential to the therapeutic approach utilized by the ChildNet programs. Therefore, issues discussed for example during a therapy session 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.
• Legal Disputes/Subpoenas
  

YOUR RIGHTS REGARDING YOUR CCI

Right to Inspect and Copy

You have a right to inspect and copy some of your CCI. However, most of your CCI may be mental health related which may not always be accessible to you.

Right to Amend

If you feel that your CCI is incorrect or incomplete, you have a right to amend the information.

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 our own uses for treatment, payment and overall agency operations, as those functions are described above.

Right to Request Restrictions

You have the right to request restrictions or limitations on the CCI we use or disclose about you for treatment, payment, or operations. You also have the right to request a limit on the CCI we disclose about you to someone who is involved in your care or the payments of your care. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

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 anytime. Please contact the ChildNet Privacy Officer, in writing, and request a copy.

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 agency 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 the agency.

COMPLAINTS

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. You will not be penalized for filing a complaint.

LOCATIONS
ChildNet Youth and Family Services

Foster Family Network
900 El Wardlow Road
Long Beach, CA 90804
(562) 492-9527

Zinsmeyer Academy
4223 Anaheim Street
Long Beach, CA 90804
(562) 961-6350

Behavioral Health Services
2931 Redondo Avenue
Long Beach, CA 90806
(562) 490-7600