KBH Policies and Procedures

The following sub-sections provide an overview of services provided by Kind Behavioral Health,"KBH", and outline the relationship between you (“Client”, or, “Customer”) and KBH, including policies, procedures, and applicable consent forms that are required prior to the start of services.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOUR CHILD MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

KBH is required by applicable state and federal law to maintain the privacy of your child’s protected health information.  In this notice, “child” refers to your son or daughter, whether by birth or adoption, or any other minor for whom you are legally responsible.  Protected Health Information (“PHI”) is any piece of information in your child’s medical record that was created, used, or disclosed during the course of diagnosis or treatment that can be used to personally identify your child. PHI includes all identifiable health information regarding your child, maintained or transmitted by KBH and its staff, in any form or medium, whether electronic, on paper, or oral.  PHI is protected under the Health Insurance Portability and Accountability Act (“HIPAA”). 

This notice summarizes the privacy practices that will be followed by KBH and your rights concerning your child’s PHI.  This notice applies to all of the records of your child’s care and billing for that care that are generated or maintained by KBH, whether made by KBH personnel or other health care providers.  This notice will remain in effect until KBH replaces it.  KBH reserves the right to change this notice.  KBH also reserves the right to make the revisions effective for medical information it already has about your child as well as any information it may receive in the future.  KBH will post a copy of the revised notice on the KBH website and in its office.  If the notice changes, a copy will be available to you upon request. 

For more information about KBH’s privacy practices, or for additional copies of this notice, please contact KBH using the information at the end of this notice. 

USES AND DISCLOSURES OF YOUR CHILD'S PHI

We may use and disclose your child’s PHI for purposes related to treatment, payment, and health care operations.

Treatment. Your child’s PHI will be used to provide medical treatment. “Treatment” is the provision, coordination, or management of health care and related services. It includes, but is not limited to, consultations and referrals. For example, KBH may disclose your child’s PHI to direct support staff (such as a board-certified behavioral analyst, a registered behavior technician, Clinic Director, or adminsitrative staff providing support functions such as intake or scheduling), doctors, psychologists, licensed psychological associates, or other healthcare providers involved in your child’s treatment.

Release of Medical Information: Kind Behavioral Health may share information related to my child’s treatment, including treatment plans, progress updates, and, when applicable, notification of changes in service status, with the Primary Care Provider (PCP) listed in our records. This information may be shared for the purpose of care coordination, provider collaboration, and supporting continuity and quality of care. It is your responsibility to keep the current Primary Care Provider on record current and accurate. Please contact your Intake or Diagnostic Operations Specialist in the event of any changes or updates.

Team Communication. Avoiding the sharing of direct support staff (e.g., BCBA, RBT, Clinic Director) personal contact information is preferred to ensure protection of PHI and communication through appropriate channels, as well as to avoid potential dual relationships that may arise therein. Families will be required to utilize MSTeams as our HIPAA-compliant method of communication with their clinical teams.

Communication by SMS Texting. Kind Behavioral Health (KBH) offers optional SMS text messaging for care‑related communication, including intake confirmations, scheduling updates, appointment reminders, and support responses.

SMS participation is voluntary and not required to receive services. Clients may choose whether to opt in through our application form.

If a client opts in, they will receive non‑marketing text messages from KBH. Message frequency varies. Standard message and data rates may apply.

Clients may opt out at any time by replying STOP to any KBH text message. For assistance, clients may reply HELP, email us at intake@kindbh.com, or contact our office directly.

Payment. Your child’s PHI will be used and disclosed to obtain payment for the care provided by KBH. “Payment” includes, but is not limited to, actions to determine eligibility for benefits and processing payment for treatment or services received from KBH. For example, KBH may disclose your child’s PHI for verification of insurance coverage and benefit eligibility and to receive payment for services from third party payors, as applicable.

Health Care Operations. Where permitted by state and federal laws, KBH may use and disclose your child’s PHI in conducting its health care operations. KBH’s “health care operations” include evaluating the performance of its staff involved in the care and treatment of your child or in an effort to improve their skills as health care providers. For example, information may need to be disclosed to direct support staff (such as a board-certified behavioral analyst, registered behavior technician, Clinic Director), doctors, psychologists, licensed psychological associates, providers of support services, and other personnel involved in your child’s diagnosis or treatment for both review of treatment and learning tools to provide higher quality of care.

Your Authorization. Unless you give us written authorization, KBH cannot use or disclose your child’s PHI for any reason except those described in this notice. If you give KBH an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.

Other uses and disclosures that do not require your authorization

Subject to certain requirements, KBH may use or disclose your child’s PHI in certain limited situations without your prior authorization. These situations include:

Public Health. KBH may use or disclose your child’s PHI for public health activity purposes to a public health authority where permitted under state and federal law. For example, KBH may disclose your child’s PHI, if authorized by state or federal law, if your child has been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

To Your Family and Friends and Persons Involved in Care. KBH must disclose your child’s PHI to you, as described in the Patient Rights section of this notice. KBH may disclose your child’s PHI to a family member, friend, or other person involved in your child’s treatment to the extent necessary to help with your child’s health care, so long as the professional responsible for your child’s care has not determined that such release of information would be harmful to your child’s physical or mental well-being or that the intended recipient of the information lacks a legitimate need for it. You have the right to object to these types of disclosures. KBH will use its professional judgment and experience with common practice to make reasonable inferences of your child’s best interest in allowing a person to access health information.

Emergency. As permitted by federal and state law, KBH may disclose your child’s PHI in emergency situations involving your child.

Research. You understand and acknowledge that KBH is a healthcare service provider participating in the training and development of clinicians in the field of autism diagnosis and behavior analysis. As a leading practicum site for clinicians pursuing their Masters in Behavior Analysis and Board certification, your child and/or their identifying information may come into contact with members of our clinical team who are accruing practicum and fieldwork hours beyond their core treatment team. Furthermore, KBH clinicians may present findings on the efficacy of treatment methodologies across client populations in scientific journals or industry conferences. Any client outcomes included in such publications or presentations, are included on an aggregate or anonymous basis, free of any individual client identifying information.

Required by Law. KBH may use or disclose your child’s PHI when required to do so by law, for example, when such disclosure is required by state or federal law.

Judicial or Administrative Proceeding. In certain limited situations, KBH may use or disclose your child’s PHI in response to valid judicial or administrative orders, orders of the court, and in response to a subpoena, discovery request, or other lawful process.

Law Enforcement. In accordance with state and federal law, KBH may disclose your child’s PHI for law enforcement purposes. For example, KBH may disclose your child’s PHI as necessary to comply with laws that require reporting of certain types of wounds or other physical injuries, or may be required to release PHI in compliance with ongoing law enforcement investigations when presented with valid subpoena, warrant, or court order to do so.

Abuse or Neglect. KBH may disclose your child’s PHI to appropriate authorities if KBH reasonably believes that your child is a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. KBH may disclose your child’s PHI to the extent necessary to avert a serious threat to your child’s health or safety or the health or safety of others. KBH will often inform you of the disclosure unless doing so would cause a risk of harm or we reasonably believe that you may be responsible for the abuse, neglect, or other injury and that informing you would not be in the best interest of your child.

Serious Threat to Health or Safety. KBH may disclose your child’s PHI, consistent with applicable law and standards of ethical conduct, if necessary to prevent or lessen a serious threat to health and safety. For example, the KBH professional responsible for your child’s care may disclose your child’s PHI to prevent or lessen a serious and imminent threat to the health or safety of a person or the public in general.

Public Health Oversight Activities. Where authorized under state and federal law, KBH may disclose your child’s PHI for health care oversight activities. For example, KBH may disclose your child’s PHI to a health oversight agency for such activities as audits, investigations (civil, administrative, or criminal), inspections, licensure, or other activities necessary for appropriate health care oversight.

Coroners, Funeral Directors, and Organ Donation. Where permitted under state and federal law, KBH may disclose your child’s PHI to a coroner or medical examiner for the purpose of identifying your child should your child die, identifying the cause of death, or performing other activities authorized by law. KBH may also disclose your child’s PHI to a funeral director, as authorized by state and federal law, in order to permit the funeral director to carry out his or her duties. Your child’s PHI may also be used and disclosed for cadaveric organ, eye, or tissue donation purposes.

National Security and Intelligence Activities. KBH may disclose your child’s PHI to federal officials for the conduct of intelligence, counter-intelligence, and national security activities authorized by law.

Uses and disclosures that require your written authorization:

Except for the general categories of uses and disclosures of your child’s PHI for treatment, payment, and health care operations and other special situations described above, KBH must obtain your written authorization in order to use or disclose your child’s PHI.  KBH shall be required to obtain your written authorization prior to the use or disclosure of your child’s PHI for marketing purposes, except if the communication is in the form of a face-to-face communication made by KBH to you or in the form of a promotional gift of nominal value provided by KBH. KBH will not participate in the sale or monetization of your child’s health data or personal health information.

You may cancel an authorization whenever you choose, as long as your withdrawal is in writing.  If you cancel your authorization, KBH will no longer use or disclose your child’s PHI for the reasons indicated in the authorization.  You understand that KBH is unable to take back any disclosures already made prior to your cancellation.  Uses and disclosures related to your child’s PHI not described in this notice will be made only after your authorization is obtained.   

 

PATIENT RIGHTS

When it comes to your child’s PHI, you have certain rights. This section explains your rights and some of KBH’s responsibilities.

Right to Inspect and Copy. You have the right to look at or get copies of your child’s PHI, with limited exceptions, for as long as the information remains in our records. In addition, you have the right to request an amendment to your health information. Any requests to inspect or copy your child’s PHI must be provided to KBH in writing. KBH may charge a reasonable, cost-based fee for the costs of copying, mailing, and/or other supplies associated with your request.

Right to an Accounting of Disclosures. You may have the right to receive a list of instances in which your child’s PHI was disclosed for purposes other than treatment or certain other activities for the six (6) year period prior to the date of your written request. KBH will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked KBH to make). KBH will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another accounting within twelve (12) months.

Right to Request Restrictions. You may request, in writing, that we place additional restrictions on our use or disclosure of your child’s PHI. KBH is not required to agree to these additional restrictions, but if KBH does, it will abide by any such agreement (except in an emergency).

Right to Amend. You may request that KBH amend your child’s PHI. Your request must be in writing, and it must explain why the information should be amended. KBH may deny your request under certain circumstances.

Right to Breach Notification. KBH will investigate any discovered unauthorized use or disclosure of your child’s unsecured PHI to determine if it constitutes a breach of the federal privacy or security regulations. If KBH determines that a breach has occurred, we will notify you of the breach and advise you of what we intend to do to mitigate the damage (if any) caused by the breach.

Right to Request Confidential Communications. You have the right to request that KBH communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that KBH only contact you at work or by mail, or at another mailing address other than your home address. KBH will endeavor to accommodate all such reasonable requests. KBH will not ask you the reason for your request. To request confidential communications, make your request in writing to the contact person identified below and specify how or where you wish to be contacted.

Right to Request Alternative Communication. You may request, in writing, that KBH communicate with you about your child’s PHI by alternative means or to alternative locations. KBH will accommodate reasonable requests.

Right to a Paper Copy of this Notice. You have the right to a paper copy of this notice or any revised notice, even if you have agreed to receive the notice electronically. To obtain a paper copy of this notice, please submit a request in writing to the contact person identified below. KBH will provide you with a copy of the notice promptly in response to your request.

 

QUESTIONS AND COMPLAINTS

If you want more information about KBH’s privacy practices or have questions or concerns, please contact us. 
If you are concerned that KBH may have violated your privacy rights, or you disagree with a decision KBH made about access to your child’s PHI or in response to a request you made to amend or restrict the use or disclosure of your child’s PHI or to have KBH communicate with you by alternative means or at alternative locations, you may file a complaint with us using the contact information listed at the end of the notice.  You may also file a complaint with the U.S. Department of Health and Human Services for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington D.C. 20201, calling 877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.  You may also contact Disability Rights of NC at (919)-856-2195 or at www.disabilityrightsnc.org, as well as your insurance company. If you need the contact number for your MCO, please reach out to KBH’s main office at 919-371-2848 or info@kindbh.com.  
 
KBH supports your right to the privacy of your child’s PHI.  KBH will not retaliate in any way if you choose to file a complaint with KBH or with the U.S. Department of Health and Human Services. 

You can complain if you feel KBH has violated your right by contacting us:  

Contact Person Name: Brandon Garcilazo

Contact Person Phone Number: (919) 371-2848

Contact Email: brandon@kindbh.com

Contact Address: 4000 Sancar Way, Suite 410, Durham, NC 27713

This document describes the agreement for professional ASD diagnostic and ABA services and the agreed upon limits of those services, and the rights and protections afforded under the Behavior Analyst Certification Board’s Professional, corresponding Behavior Analyst Licensure Boards, Psychologist Boards, the Ethical Compliance Code for each profession. I may request a copy of this document for my records at any time.  

What are ASD diagnostic services. An autism diagnostic evaluation is a comprehensive, multi-step process conducted by specialists (licensed psychologist or licensed psychological associate) to determine if a person meets Autism Spectrum Disorder (ASD) criteria as established by the DSM-5. It involves reviewing developmental history, observing behavior, and using standardized tools to assess social communication, repetitive behaviors, and sensory responses.
 
What is behavior analysis. Behavior analysis is a treatment based on the concept that human behavior is learned, and learning occurs across time. Behavior analysts collaborate with you to influence your child’s behavior, either to increase skills, and/or to decrease challenging behaviors, by designing and implementing individualized treatment plans of care with each client and family. Behavior analysts identify what is maintaining behavior, discover appropriate replacement behaviors, and set up a plan to enable alternative responses to occur (antecedent strategies) and follow the behavior with positive consequences (reinforcement).  
 
Treatment hours for behavior analysis. Research has demonstrated that ABA treatment is most effective when applied daily, at high intensity (up to 40 hours per week), in the most applicable locations for the behaviors being targeted in each treatment plan. Research has also indicated that treatment of less than 15 hours per week tends to produce less successful clinical outcomes. Our treatment approach is to initially work with your family more aggressively, transferring techniques and education from therapy into your home environment, and considering discharge criteria ongoingly. As a general guideline, most clients with whom we work tend to receive treatment that is structured as either Comprehensive (35-40 hours per week), Focused-High (20-25 hours per week), or Focused-Low (15 hours per week), depending on the breadth of treatment plans and number of behavioral skills and goals being targeted. 
 
Objectivity. Our licensed psychologists, licensed psychological associates, and licensed behavior analysts do not make personal judgements about behavior in all professional services we offer.

For clients enrolled in ABA services, our behavior analysts seek to understand behavior as an adaptive response (a way of coping) and suggest ways of adjusting and modifying behaviors to reduce pain and suffering and increase personal happiness and effectiveness to maximize quality of life for our clients and their caregivers. KBH’s ABA services focus our treatment on behaviors that are socially significant for each client. Understanding behavior occurs through observation, testing, and data analysis.
 
Child-specific results. Please know that it is impossible to guarantee any specific results for a child.  However, together we will work to achieve the best possible outcomes, given your scheduling abilities. If, at any time, our clinical staff, including our licensed behavior analysts, licensed psychologists, or licensed psychological associates believe that consultation has become non-productive, they will discuss transition planning and discharge out of services, providing referral information as needed and available.
 
Consent for services. I agree to have my child/dependent participate in evaluation, assessment, and/or ABA treatment services provided by Kind Behavioral Health.  I understand that the specific activities, goals, and outcomes of services will be fully discussed with me and that I can ask for any clarifications ongoingly.  I also understand that I have the right to ask follow-up questions throughout services to ensure my full consent.  I understand that my child/dependent is the primary client and that services will be designed primarily for his/her benefit. KBH team members will consistently assess whether clients are assenting to treatment through direct (verbal communication) or indirect measures and will pause services in instances in which client assent is, or appears to be, withdrawn.

Never Alone: KBH requires a second individual over the age of 18 to be present during sessions occurring outside the clinic who is either the caregiver/legal guardian, OR an individual appointed by the caregiver/legal guardian. Appointed individuals must have decision-making authority over care and the ability to intervene as needed in the case of an emergency. In the event the responsible party is an appointed individual, KBH reserves the right to terminate the session if at any point it is determined that the environment has become unsafe for the client or our team members. If session is terminated by a KBH team member, the legal guardian will be contacted with information outlining what led to session termination.  

Waiver and Release. I understand that Kind Behavioral Health makes all reasonable efforts to ensure the safety and well-being of every client we serve. Kind Behavioral Health intentionally designs clinic spaces and utilizes appropriate safety equipment to protect all clients’ well-being, particularly in contexts during which challenging behavior may occur. Kind Behavioral Health also maintains and seeks to enforce illness policies in a best effort to keep all clients safe from illness and other communicable diseases.

With that said, I also understand that accidents may sometimes occur in high-activity clinic settings (for example, when using swings or other play equipment), in which clients may be injured, and/or personal property may be damaged. I also understand that transmission of colds or other illnesses cannot be fully avoided.

I understand these risks and voluntarily choose to accept these risks in enrolling my child in the services offered by KBH. I hereby release from liability and waive my right to sue Kind Behavioral Health, their employees, officers, directors, and any other affiliated parties from any and all claims, including claims of negligence, resulting in any personal injury, illness (including death), property damage, economic loss, or any other claims arising from, or in connection with, my child’s participation in services.

Emergency. In the event of an emergency, I give KBH permission to seek medical attention for my child/dependent at the nearest hospital location from the place of service.  
 
Documentation. I can access documentation pertaining to treatment, including the results of any ASD diagnostic evaluation, ABA assessment and Behavior Improvement Plans on my Central Reach parent portal. I can also request a printed copy.  The documents will be explained to me and any questions I have will be answered to my satisfaction. 

Diagnostic Evaluation. I understand that ASD diagnostic evaluations follow a multi-step process.

First, you will have a consultation with a Licensed Psychologist (LP) or Licensed Psychological Associate (LPA). During this appointment, the LP/LPA will review developmental history and discuss your concerns in detail. Second, there is an in-person diagnostic evaluation at one of KBH’s clinic locations. This includes standardized assessment tools, behavioral observations, and direct interaction with your child. Finally, there is a results meeting, held virtually, where findings and recommendations are reviewed and the diagnostic report is provided.

KBH’s ASD diagnostic evaluations are a process, not a guaranteed diagnosis. A diagnosis is made only if it is clinically supported.

ABA Assessment. I understand that my child’s first several sessions consist of assessment activities designed to (a) evaluate his/her current skills, (b) determine the specific ABA strategies and interventions likely to prove most effective, and (c) review and align on scheduled services and caregiver involvement in care delivery. If services include improving challenging behaviors, I understand that functional assessment activities (e.g., interviews, checklists, direct observations) may also be required to provide information for the development of an individualized Behavior Improvement Plan.
 
ABA Treatment. Ongoing treatment includes ABA education, intervention component details, and direct practice for family, educators, and/or other service providers. KBH’s goal is to equip caregivers to carry forward clinical progress and gains made beyond the duration of direct services with our staff. I understand and acknowledge that full participation in both training and implementation is critical for successful outcomes.  Ongoing data collection permits evaluation effectiveness and will assist to identify required revisions to ensure treatment outcomes. Treatment also includes an ongoing evaluation towards transition planning and discharge. We also will continually evaluate and discuss the ongoing benefit of services, discharge/graduation criteria, and any barriers to effective and/or efficient treatment.  
 
Science-based. KBH is ethically obligated to provide scientifically supported treatment. I am aware that other interventions that I may be pursuing affect my child’s behavior, and his/her response to treatment. For children in ABA treatment, it is important to make the behavior analyst aware of those interventions and to partner with the behavior analyst to evaluate any associated therapeutic or detrimental effects of those interventions.  
 
Clinical support team. I understand that KBH employs individuals who have completed secondary education (high school diploma or equivalent) and/or hold a Bachelor's degree, all of whom operate under the supervision of Master's-level Board Certified Behavior Analysts (BCBAs) and Doctoral-level Licensed Psychologists (LPs). I understand that my child’s services will be overseen and observed by supervisors or other employees as part of ongoing training and quality assurance activities. Furthermore, I understand and acknowledge that KBH is a training and practicum site for many clinicians, and my child may be observed by other employees of KBH in an effort to provide training and development opportunities for students of behavior analysis. Events occurring in those sessions will be discussed in closed supervision meetings, and client PHI will be protected and only shared on an as-needed basis. I may request a copy of my clinical team's professional credentials. In addition, any concerns that I have about my clinical team's performance can be directed to KBH’s corporate office. 
 
Use of media. I understand that it may be necessary to audio- or videotape assessment and/or treatment sessions for supervision purposes. I hereby give permission to KBH to maintain video surveillance of my child in the clinic, use my child's photograph(s) and/or videotaped image(s) and sound byte(s) to communicate progress with me, to secure a sample of behavior to use in data analysis in marking program effectiveness, in staff training, and educational seminars.  I willingly agree to have my child's photograph(s), videotaped image(s), sound byte(s) taken during the course of treatment. 

 

 

 

 

Caregivers are actively involved in ABA treatment. Being involved in your child’s treatment makes a huge impact on their learning and progress. Research has shown that caregiver involvement leads to better outcomes for your child and your family. Your team will develop treatment that is unique to your child’s needs and your family’s priorities, culture, values, and goals. You will be involved in helping design your child’s Plan of Care (POC) by answering interview questions, giving input about your child’s needs, and partnering with us to teach your child outside of KBH direct treatment hours. All caregivers must meet with their Board Certified Behavior Analyst (BCBA) 2-4 times per month to review progress, areas of concern, to practice how to use ABA strategies, ask questions, and agree on how to move forward in therapy. 
 
Caregivers adhere to their child’s medical recommendation. Most autistic children require between 15-40 hours per week of ABA treatment. We recognize that, while this is a much higher time commitment than other therapies your child may be receiving currently, it is this level of intensity that makes ABA therapy effective and eventually leads to graduation from services. Your child’s medical recommendation will be noted in your child’s POC and determined based on their unique presentation of autism, the level of support needed to learn, and the number of areas aiming to be addressed in therapy. Most clients typically fit into one of three general treatment models, which are Comprehensive (35-40 hours per week), Focused-High (20-25 hours per week), or Focused-Low (15 hours per week). For your child to achieve and maintain optimal results, our team will support you by understanding your availability to best schedule services while also adhering to our scheduling compliance requirements. Our goal is for all clients to receive services at the medically recommended treatment dosage. However, we recognize that scheduling conflicts or cancellations may occur, which may result in sessions that cannot be rescheduled or made-up. Taking these factors into account, KBH requires that families receive services at or above 80% of the medically recommended dosage on an ongoing basis to ensure the continued efficacy of treatment on an ongoing basis. Failure to schedule services and attend sessions accordingly may result in the pausing or discontinuation of services.  
 
Caregivers commit to a consistent ABA schedule. Consistent schedules become predictable and beneficial to your child, your family, and our team members. KBH expects caregivers to schedule therapy for five days, Monday to Friday, at the same time each day. We currently offer different time blocks that you can select from, including morning block (8:00AM – 11:00AM), daytime block (12:00PM – 3:00PM), or evening block (3:30PM – 6:30PM). The hour between 11:00 AM and 12:00 PM may be used to extend morning block sessions longer or start daytime block sessions earlier. Our team will offer some flexibility, as needed by your family, to agree on a schedule that works for your child, adheres to our scheduling guidelines, and does not compromise the effectiveness of ABA treatment. 
 
Caregivers maintain a professional relationship with their team. Specific guidance is given to our clinical team to always ensure professional and ethical behavior when interacting with you and your child. The primary and only relationship our team will have with your family is one that focuses on your child’s ABA treatment. No other relationship or activity outside of ABA treatment is permitted by the BACB’s Professional and Ethical Compliance Code. We recognize that part of the work that we do involves having personal interactions and discussions with you about your child and family life, and we respectfully ask caregivers to keep topics, conversations, and interactions professional. The BCBA will determine whether any activity outside of treatment requires ABA support and coordinate it to the extent possible to ensure no other types of relationships are formed.  
 
Caregivers engage in timely and treatment-focused communication. Caregivers will be required to utilize MSTeams to communicate with their team members to ensure both the protection of your child’s PHI and the sharing of our team’s personal contact information. Ongoing communication between caregivers and our team is extremely important. It allows everyone to be on the same page and share key information to best support your child each day. The more we know, the better we can serve you and your family. Caregivers are asked to respond to all communications about their child on the same day and, if unable, within 24 hours. Our team will strive to check-in with you at the start and end of therapy, to understand anything that may have happened beforehand, and to update you on how therapy went. At times, we will also communicate with you while your child is in therapy, to inform you of changes, illness, need for support, or to ask additional questions if unexpected events arise. Your team will need to know the best and quickest way to reach you and respond to you in a timely manner. All caregiver-initiated communications must remain focused on treatment and related to your child’s needs.   
 
BACB Compliance Code. Our services are rendered in a professional and ethical manner, consistent with the accepted Professional and Ethical Compliance Code by the BACB. If at any time and for any reason you are dissatisfied with the nature of the professional relationship with your team, contact your service location’s Clinic Director or KBH’s corporate office. 

Consistent and timely attendance at the agreed-upon schedule helps your child receive treatment as outlined in their Plan of Care. Your child is likely to do best when the program is well-designed and can occur without disruptions to schedule treatment. Timely communication, advance notice, and efforts to reschedule cancelled services ensure that our team can plan accordingly to deliver ABA services to your child. The success of ABA treatment depends on all parties (caregiver, RBT, BCBA) doing their part to keep changes or cancellations to a minimum. KBH enforces the following attendance expectations: 

• Child attends greater than 85% of scheduled services every month. Any predictable event that is expected to interfere with your ability to follow your child’s ABA schedule must be communicated to your BCBA right away. This will help your team plan well for the weeks ahead. When cancellations are unavoidable, the caregiver and team will make every effort to reschedule cancellations by extending the duration of future therapy sessions. The rescheduled therapy is ideally provided by your assigned team but, if they are unable or out of office, KBH will do their best to identify a substitute team member that can effectively deliver your child’s treatment. KBH has specific staffing and shadowing guidelines in place which will ensure that only substitute pairings which are deemed to be safe and effective will be considered for substitute coverage. 
• Child arrives and departs on time every day. Reliable start and end times are necessary for effective services, so we ask that you ensure your child is present for the full duration of their therapy. Tardiness or early pick-up is any instance where the caregiver is more than 15 minutes from scheduled start and/or end time. We understand occasional circumstances that may impact timeliness, and permit fewer than 3 occurrences per month. Our team members often have sessions back-to-back, so it is important that caregivers pick-up on time. If a caregiver is more than 15-minutes late to pick-up their child, more than twice in any given month, KBH reserves the right to ask that sessions move to the home or for the caregiver to remain on-site for the duration of their child’s therapy session.  
• Caregivers adhere to the agreed-upon schedule for ABA services. Adhering to the recurring schedule ensures that it remains aligned with your RBT’s availability and that there is continuity of services without disruption. Any request to change your schedule to another time block must be communicated to your BCBA with 30-days' notice and can introduce the risk that the current RBT or BCBA might not be able to remain on the team. The 30-day notice will provide us with enough time to do our best to keep your team members or identify a new team member with an availability that matches your new scheduling needs, in an attempt to avoid having to rejoin the waitlist for services. KBH asks caregivers to limit their requests to change their ABA schedule to no more than 3 times per calendar year. 
• Caregivers participate in family training as recommended by their BCBA. Just as it is critical for each client to receive services as medically recommended, so does the success of ABA treatment hinge on recommended family/caregiver participation in services. Depending on your child and family’s needs, your BCBA will develop a recommended level of caregiver training and will work strongly with you to deliver this family training that empowers you to manage your child’s behavior and apply ABA strategies. Based on your expressed parenting needs and/or areas where you experience higher stress, your BCBA will select the topics that are most relevant and can benefit you the most. Family training will be delivered individually to you each month. KBH also offers other opportunities for group family training where you can learn with other families, listen to and share experiences, and gain additional social support and community. All caregivers must meet with their BCBA 2-4 times per month to review progress, areas of concern, to practice how to use ABA strategies, ask questions, and agree on how to move forward in therapy. 
   

Providing advance notice whenever possible supports our efforts to drive consistent service delivery to your child and family. Caregivers will give 24-48 hours’ notice for any unexpected changes and a minimum of 2 weeks' notice for planned vacations. The greater advance notice provided to your clinical team, the better the likelihood of KBH’s ability to plan accordingly and preserve staff availability. 
 
If caregivers feel that RBT cancellations or tardiness become excessive, please contact your BCBA directly to discuss.  

KBH is committed to maintaining a safe and healthy environment for all children and team members. We ask that caregivers cancel sessions if their child shows any signs of being sick. While we understand short notice may be necessary, we depend on caregivers to follow these health guidelines to protect everyone in our care.

Please cancel your session if your child shows any of the following symptoms within at least 24 hours of the scheduled appointment. If it is 24 hours before the scheduled appointment and you are uncertain whether to cancel due to potential illness, please check in with us early to help plan:

• Fever of 100.4°F or higher
• Any signs of breathing distress
• Cough or sinus issues (e.g., yellow or green mucus, cough with phlegm)
• Nausea, vomiting, stomach pain, diarrhea or acute discomfort, including:
  • vomiting or 2 or more episodes of diarrhea (abnormal frequent, loose or watery stool movements) within 24 hours; or
  • stomach pain that continues for more than 2 hours or intermittent pain associated with fever or other symptoms.
• Flu-like symptoms (fever, chills, nausea)
• Any highly spreadable illnesses (including but not limited to Hand, Foot, Mouth Disease, Chicken Pox, Measles, Mumps, RSV, Rubella, Mono)
• Strep Throat
• Hand, Foot, and Mouth Disease
• Conjunctivitis (pink eye)
• Lice, bed bugs, or other visible parasites
• Skin infections or rashes (e.g., MRSA, hives)
   

When Can Treatment Resume After an Illness?

Colds, fevers, vomiting, sinus infections	Child must be symptom-free, including no fever (and is not using fever-reducing medicine) for 24 hours.
Respiratory virus symptoms	Getting better overall for at least 24 hours.
Vomiting	Has resolved overnight and the child can hold down food / liquids in the morning.
Diarrhea	Has improved, the child is no longer having accidents or is having bowel movements no more than 2 above normal per 24-hour period for the child. Bloody diarrhea should be evaluated by a healthcare provider prior to return.
Strep throat or pink eye	Child must be symptom-free for at least 48 hours after starting given by a doctor antibiotics
Lice	Child must be lice-free for at least 72 hours after treatment with medicine
Hand, Foot, Mouth Disease	No fever (and is not using fever-reducing medicine) for at least 24 hours, no visible signs of discomfort, and no new sores
Highly spreadable diseases (e.g. Chicken Pox, Rubella):	A physician’s release is required to resume treatment
Skin rashes or infections	48 hours after topical cream treatment

If your child is showing symptoms of any of the illnesses listed above at the time of cancellation, treatment will be paused until the earliest time without symptoms required for that condition has been met. If that timeframe has passed and your child is still showing symptoms, please let us know as soon as possible so we can plan ahead.

• If Your Child Becomes Ill During a Session:
  • Your clinical team may decide to end the session early. If symptoms worsen or pose a risk to others, we will contact you (or an authorized adult), and you are expected to pick up your child within two hours.
• If the Provider Cancels:
  • Our scheduling team will work closely with the clinical team member to find a substitute for your child's session to maintain consistency in care.
  • If a replacement is unavailable, we will alert you via text as soon as possible and will work with you to timely reschedule.

KBH takes all grievances seriously. In the event of an alleged grievance the family will discuss verbally or in writing any grievance with a member of the KBH team, including their BCBA, or KBH’s Clinic Director and (b) KBH will investigate and make every effort to resolve to the client’s satisfaction within 7 days. If the grievance cannot be resolved, the client is to notify KBH’s Clinical Director in writing. If the client feels that his/her grievance has not been resolved after working with KBH, the client should be aware of other resources that are available to assist. For example, the client may reach the North Carolina Psychology Board at (828)-262- 2258 or on the web http://www.ncpsychologyboard.org/filingacomplaint.htm or the Behavior Analyst Certification Board at http://bacb.com, or the North Carolina Behavior Analyst Licensure Board at https://ncbehavioranalystboard.org, or the Georgia Behavior Analyst Licensing Board at https://sos.ga.gov/georgia-behavior-analyst-licensing-board. Further, the client may contact Disability Rights of NC at (919)-856-2195 or at www.disabilityrightsnc.org, as well as his/her insurance company. If you need the contact number for your MCO, please reach out to KBH’s main office at info@kindbh.com.

ASD Diagnostic Evaluations

Kind Behavioral Health offers comprehensive ASD diagnostic evaluations as a private-pay service. Evaluations are not billed to insurance and must be paid directly by families according to the fee schedule and payment policy outlined below.

The fee covers the full diagnostic process, including:

• Virtual LP consultation
• In-person diagnostic evaluation and administration of standardized assessments
• Diagnostic report preparation
• LP review and sign-off
• Review of diagnostic findings and recommended next steps

Families are paying for the evaluation process, not for a guaranteed diagnosis. A diagnosis is made and indicated in resulting diagnostic reports only if clinically supported, per applicable medical diagnostic criteria.

Total Service Cost

$1,000 (private pay)

Paid in two installments

Payment Structure

1. First Payment – $500 Non-Refundable Deposit

Purpose: To secure the family’s appointment with the Licensed Psychologist and reserve evaluation time.

Due Date: Must be paid 10 days before and no later than 7 days before the in-person diagnostic evaluation.

Policies:

• Non-refundable under all circumstances.
• If Kind Behavioral Health must reschedule due to provider or office needs, we will offer the earliest practicable alternative appointment.
• If the deposit is not received at least 7 days prior to the in-person diagnostic evaluation, the reserved evaluation slot may be reassigned to another family. Appointments will be rescheduled only after eventual receipt of this first payment.

Additional Scheduling & No-Show Policies

• Please arrive on time for your scheduled appointment with our Licensed Psychologist (LP) and complete all required paperwork in advance. Doing so helps us maintain the schedule and support consistent access for all families.

• If required paperwork is not completed or advance notice is not provided, your appointment may be released.

• Families should arrive 15 minutes prior to your in-person diagnostic evaluation.

• You may be assessed a $250 rescheduling fee if you do not attend or arrive late to an appointment.

• For the final virtual readout, if the family does not attend and is unresponsive to rescheduling, the report will not be released.

2. Second Payment – $500 Final Payment

Due and payable to KBH upon receipt of invoice, and no later than 10 days after in-person diagnostic evaluation is performed.

Policies: Failure to submit the second payment may delay the results meeting and issuance of the diagnostic report.

What the Fee Does Not Guarantee

Families are paying for a diagnostic evaluation, not a particular outcome. Payment does not guarantee:

• An ASD diagnosis
• Access to ABA services
• Confirmation of concerns suggested by providers, teachers, or counselors

The final diagnostic determination is based solely on the clinical judgment of the diagnosing provider, and the presence of appropriate DSM-5 diagnostic criteria.

Accepted Payment Methods - PayPal Invoicing

All evaluation payments are processed exclusively through PayPal invoicing.

Families may pay invoices using:

• Credit or debit cards
• HSA or FSA debit cards (accepted when permitted by the card issuer)
• PayPal account balance

Our team will send a Superbill, a detailed, itemized receipt, should you choose to submit for insurance reimbursement.

ABA Treatment

All services provided by a Board-Certified Behavior Analyst are billed at $295.00 / hour.

Such services include, but are not limited to: Assessment development, parent/family consultation, direct instruction, behaviorplan creation, program modification, family training, supervision of RBT staff or non-KBH staff, and offsite programming. Service plans will be individualized to the needs of the family and child and presented prior to the onset of services.

 

All services provided by a Registered Behavior Technician are billed at $150.00 / hour.

All services provided by a Registered Behavior Technician are billed at $150.00 / hour. Such services include, but are not limited to, direct instruction and team meeting attendance. Typically, a range of 10% - 30% (and no less than 5% in any given month) of the RBT’s direct treatment hours will be supervised by a BCBA and be billed for the BCBA’s time for any program modification done, as well as the RBT’s time for any direct treatment provided.

Many clients have healthcare insurance that includes coverage for ABA services, and services are typically paid for, at least in part, by client’s insurance payor(s). Insurance coverage represents a contract between you and your insurance company(ies). We will bill your primary and secondary insurance companies for services rendered, as a courtesy to you. To properly bill your insurance company(ies), we require that you disclose all insurance information including primary and secondary insurance coverage, as well as provide KBH with notice of any expected changes to insurance coverage as soon as possible, and prior to the effective date of any changes to coverage. Failure to provide complete and accurate insurance information, or advance notice of upcoming changes may result in amounts owed falling to patient responsibility. 

Your insurance company will make the final determination of your eligibility and benefit. You will be notified of your eligibility for ABA coverage prior to the start of services. Our team will send a Benefits Eligibility Verification Form via email to the email address we have on file, once your ABA benefits have been verified with your insurance company and may arrange a financial consultation call to review this information with you prior to the start of services. Be sure to look over this form and contact us immediately if you have any questions, or if any information needs to be updated. A quote of benefits and/or authorization from your insurance company does not guarantee payment. Payment of benefits is subject to all terms, conditions, limitations, and exclusions of the member's contract at the time of service. You hereby acknowledge and agree to pay any portion of billed charges not ultimately covered by your insurance. 

Depending on your insurance coverage, and the specific benefits relating to ABA coverage, you may be required to pay for portions of coverage out-of-pocket, including, but not limited to co-pays, coinsurance, and annual deductibles. Despite being pre-authorized services, initial denials for reimbursement of ABA services are commonplace and can often take many attempts from ABA providers to collect payment from insurance for services rendered. Some insurance plans have a yearly ABA Benefit Maximum amount that the insurance company will pay. Once such maximum benefit amount has been paid, all subsequent ABA services may be deemed by the payor to be patient responsibility. Any applicable ABA Benefit Maximum that is brought to the attention of KBH team members will be noted on your Benefits Eligibility Verification Form.

KBH requires all clients to maintain an active credit card on file to cover all patient responsibility balances owed. Billing is done on a bi-monthly billing cycle. Typically, services for the first through the fifteenth of each month are billed together, and then the sixteenth through the end of the month are billed together. Since we are on a bi-monthly billing cycle, on average you will receive two statements a month. All statements are made available in the client Central Reach portal. You can enable notifications in your Central Reach account to be notified when a new statement is available.

When a new statement is made available in Central Reach, you will have a 72-hour window to review your balance and make sure it is correct. If everything looks good, no further action is needed. If you have questions or concerns, please reach out to the billing department to discuss further. After this 72-hour review period, charges will be assessed to the credit card on file. If, at any point, you wish to update the credit card you have on file, please reach out to the billing department, and they will be happy to update this for you. If you are paying with an HSA card, we will charge for the available balance on the HSA card, but any remaining balance due will need to be paid in full. If necessary, we will reach out for another payment method to cover any remaining balance due. We will be happy to provide a detailed receipt that you can subsequently submit to your HSA for reimbursement.

If for any reason we are unable to charge the total invoice balance due amount to the Credit Card on File and payment is not received within 30 days, services may be suspended. If no resolution can be made, services may be paused until balances have been paid in full. You may or may not be placed back on a waitlist for services. While we seek to avoid having to do so, on occasion, unpaid patient balances owed may be sent to a collection agency, or attorney. In the event an account is turned over to collections, the person financially responsible for the account will be responsible for all collection costs, including attorney fees and court costs.

We recognize that healthcare costs can be significant and often complex. If you have questions or need assistance, please don’t hesitate to contact our billing team. We offer flexible zero-interest payment plans to help ease the financial burden. Additionally, we can provide information about external resources such as grants and scholarships that may be available to assist with service costs.

I hereby authorize KBH to furnish my insurance carrier with any information acquired in the course of my child’s / dependent’s evaluation or treatment necessary to complete my insurance forms and submit requests for payment.  Also, I hereby assign to KBH the authority to bill my insurance provider for payments associated with any and all services rendered.  In the event that my insurance company does not pay for services rendered, I understand that I am fully responsible for all additional payments due for services. 
 
By providing your name and signature below, you represent that you acknowledge and understand the above information.  

As a patient, family member, or responsible guardian, you (or your dependent receiving services) have the right to:

• Treatment, including medical care and habilitation, regardless of race, age, color, creed, sex, religion, degree of mental illness, developmental disability, substance abuse or national origin. 
• Be free of verbal, physical, and psychological abuse. 
• Exercise any of these rights as a patient of this agency. 
• Receive the highest quality of care. 
• Be treated with respect and dignity to yourself and your property. 
• Communication in a language or form you can understand. 
• Be referred to an alternative service if the agency is unable to provide necessary care or for any reason denies service to you. 
• Voice grievances regarding treatment/care without discrimination or reprisal for voicing those grievances. 
• Access to all treatment plans and the ability to request information in advance of any changes in the plan of care. Patient medical records may be accessed through your HIPAA-compliant parent portal log in or by sending a written request to KBH at info@kindbh.com. 
• Participate in planning your care and treatment or any changes in your care. 
• Be informed in advance of any changes in the plan of care before being made. 
• Receive appropriate instruction and education regarding your care plan. 
• Be informed in the discipline of Applied Behavior Analysis and the frequency of proposed visits. 
• Confidentiality of your clinical records and be informed of the agency’s policy regarding the disclosure of your clinical records for any purpose. 
• Review your clinical record. 
• Be advised in advance of the extent to which payment for services may be expected from you. 
• Have access to all bills for service. 
• Be informed of the State Home Health Hotline number which is established to receive complaints or answer questions regarding home health care. The phone number for the North Carolina Home Health Care and Health Care Complaint Line is 1-800-624-3004. Further, you can contact the Disability Right of NC at 919-856-2195 or at www.disabilityrightsnc.org.

All patient records will remain on file for a minimum of seven years after the date of last provision of services to the client and, if the client is a minor, the records will be maintained until the later of (a) seven years after the date of last provision of services to the client or (b) three years after the age of maturity. You can request these records at any time. If you wish to see your records at any time, KBH recommends that you review them in the presence of your clinical team, so that we can discuss the contents and address any questions you may have. KBH requires a completed and signed written Request and Authorization for Release of Health Information Form before releasing any documents to anyone, including the patient himself or herself. The form must be completed, dated and signed, and also specify what specific components of your medical records you wish to be released

KBH strives to build a community where current and prospective clients, staff members, and all community members (collectively “stakeholders”) feel safe. We believe this should be granted to all that come in contact with our services. Our vision to create an environment in which ‘exceptional people can think big, have fun, and do good’ is predicated on (a) building a strong team and (b) working with clients- both from varying, different, and/or diverse backgrounds, experiences, and perspectives. We believe this vision in action will enhance all stakeholders’ experience at KBH.

KBH complies with all federal and state civil rights laws and does not discriminate, exclude, or treat people differently on the basis of age, race, ethnicity, national origin, color, creed, gender, sexual identity, religion, physical abilities, neurological functioning, and/or substance use/abuse.

KBH is committed to taking all commercially reasonable steps to ensure its stakeholders have meaningful access to the information and services at KBH.

KBH posts a non-discrimination notice in all clinic locations, as well as on our website.

Purpose

Federal and state laws require health care providers to provide services to all people without discrimination. Across all stakeholders, KBH supports and endorses non-discretionary practices, protects against discrimination, and ensures equal access to services.

KBH endeavors to meet accommodation requests to the extent practicable and motivated under clinical rationale. Accommodation requests that arise out of preference or convenience, are not practicable, or are not motivated under clinical rationale, may not be granted.

Procedures

KBH team members (including clinical or operations staff members) should complete a Clinical Accommodation Request Form when a client family/caregiver requests, or is believed to require, an accommodation to KBH’s standard service delivery parameters or for any deviation from the KBH Scope of Practice is requested. KBH requires a Clinical Accommodation Request Form be completed, clearly and concisely, using detailed and thorough information, and be submitted for review. Please provide all the information required for the team to make an informed choice.

Some requested accommodations may include:

• Language for limited English proficiency, deaf, hard of hearing, and/or deafblind
• Client Age
• Comorbidity / Other diagnosis
• Medical need / Medication administration
• Service Location / Proximity 
• Availability to adhere to the medically recommended dosage, or funding restriction (i.e., annual cap)
• Mobility or Assistive Devices (wheelchair, hearing aids, vision impairment, PECS)
• Space or environmental considerations
• Severity of challenging behaviors (aggression, elopement, self-injurious behavior)
• Request for specific clinical team member(s)
• Other
  
  

When a KBH team member is made aware that a client, family member, or caregiver is requesting, or needs an accommodation, the Clinical Accommodation Request Form in JotForm is to be completed and submitted to the Clinical Director for review. In the event an accommodation request requires additional support or resources that are not readily available, services should not be provided until the accommodation request process can be completed. No matter how easy to resolve or accommodate, all clinical accommodation requests must be documented and submitted for review, even if the individual can be (or is already being) accommodated within the clinic without additional support/resources.

A common form of accommodation may arise from families who require additional language support in the event client, family member, and/or caregiver has limited English proficiency. The remainder of this policy outlines details related to such instances.

English-language Interpreters in Non-Emergency Situations

Any interpreter services provided by KBH must adequately meet the needs of the client and family. For example, KBH may discuss with the family to use a clinician with native language proficiency that can adequately communicate directly with the family. KBH will reasonably contract with a qualified interpreter service (e.g., CyraCom, DSDHH) with interpreters who are certified and versed in medical terminology to provide services, in some non-English languages, American Sign Language, Cued Language transliteration, as determined on a case-by-case basis.

 Minimally, for approved accommodations, verbal interpreter services shall be made available for all instances of:

• Reviewing, understanding, and completing intake paperwork
• Provision of informed consent to treatment
• Review, consent, and signature of all Treatment Plans of Care, Behavior Improvement Plans, & Functional Assessments
• Periodic reviews of outcome measure and progress reports with family members

Client/Family use own English-language Interpreters

Clients and families may also provide their own interpreters or translators if they so desire. However, their ability to provide an interpreter or translator does not relieve KBH from doing so. The decision as to whether the client or family provides their own interpreter is solely at the discretion of the client/family.

In other words, if the client/family already has their own preferred interpreter, then they may use that interpreter at their discretion. If the client/family does not have their own interpreter or preferred interpreter, then KBH must reasonably provide those services. KBH cannot request that the family provide own interpreter or that another family member, besides parent(s)/guardian(s), serve as interpreter. If the client/family interpreter is considered not competent or appropriate by KBH team member, KBH reserve right to involve additional interpreter if necessary.  

Interpreters in Emergency Situations

Non-qualified interpreters (such as bi-lingual KBH staff) are permitted to interpret to KBH clients in emergency situations.

To ensure confidentiality of information and accurate communication, children and other clients will only be used to interpret in an emergency.

Translated Documents

The primary language in which KBH conducts business and provides services to most clients is English. With that being said, KBH is committed to providing written documentation to families in a language that they readily understand.  Depending on the primary language of the family/caregiver, documentation (including intake paperwork, treatment consent forms, and policies and procedures) may or may not be available in a pre-translated format.  If requisite documentation is not readily available in a language of a families native fluency, KBH will make commercially reasonable efforts to have such documentation translated for the family, free of charge to the family. 

Particularly as it relates to informed consent to service, no family shall be asked to consent to treatment or review medical documentation that they are not believed to fully understand. 

If any KBH team member discerns that a client, family member, and/or caregiver may require additional documentation translation or interpreter services to enhance their understanding of any documentation, they are to fill out the KBH Clinical Accommodation Request Form and submit the completed form to the Clinical Director for review and alignment on next steps.

 

KBH Clinical Director Contact Information:

Kerin Weingarten, PhD, BCBA-D  

PO BOX 12697, Durham NC  27709

(919) 342-6035

Kerin@kindbh.com

By signing below, you certify that you have read each of the above sections, in their entirety, and that you know and understand the meaning and intent of all sections within the document.  You are hereby representing that you are providing your signature knowingly and voluntarily. 
 

I verify that I have read, understood, and agree to comply with all above information and policies contained within this document.