Policies for ABA Therapy Services

Scope(s) of Practice for Behaviour Analysts

Behavior Analysts do not diagnose mental health conditions.  ABA therapists are trained to identify the function of behaviors through a process called a Functional Behavioral Assessment.  We also are trained to conduct a variety of adaptive behavior assessments (i.e., skill assessments), to measure skill strengths and weaknesses to inform comprehensive ABA treatment plans. 

Clinicians working in our ABA services department at Cayman ABA practice within the scope of practice for Behavior Analysis under guidelines from the Behavior Analysis Certification Board.  Cayman ABA assures that services will be rendered in a professional and ethical manner consistent with accepted ethical standards.  We are required to adhere to the Guidelines for Responsible Conduct of the Behavior Analyst Certification Board®. A copy of these Guidelines are available upon request, or on the BACB’s website at www.bacb.com.  Our treatment plans only utilize evidence-based practices, and we do not offer interventions that are not considered evidence-based. 

Cultural Awareness

Cayman ABA recognizes and respects the value of cultural diversity and will strive to ensure that your ethnic or cultural customs, practices, and beliefs, sexual orientation, gender, gender identity, gender expression, disability, and/or community is respected by all staff.  

Given the multiple nationalities and cultures represented across the three Cayman Islands, we recognize that our clinicians may not be fully versed in all cultural differences.  Please make sure to communicate to our Clinical Manager if you have any prior or on-going concerns regarding your clinician.

Operating Hours and Communication

Our business office is open Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.  We provide services year-round (including on Public Holidays), with the exception of the Christmas and Easter weeks when the clinic is closed.  

To meet the needs of our families, we often schedule therapists outside of regular business hours, including evenings and Saturdays.  Cayman ABA staff will be unavailable to answer calls after operating hours and will return your call at the earliest possible opportunity during operating hours.  After regular business hours, please leave a voicemail, and your call will be returned within 24 hours.

Communication is a vital role for many different reasons. Our goal at Cayman ABA is to respond to all emails, phone calls or texts within 24 hours during regular business hours. There may be times that we respond with a notification stating that we may need more time to respond.

Parents acknowledge to reply to phone calls or emails from staff members within 24 hours. If you do not have time to respond to the communication from a staff member within 24 hours, you can email, call or text to indicate when you will be able to respond so that we are aware that you received the communication.

Client Responsibilities

Cayman ABA can only work with clients who fully inform us of any and all of their concerns. We will need your full cooperation as we try to understand the various behaviors that are problematic for you. We will be asking a lot of questions and making a few suggestions and need your total honesty with us at all times. We will be showing you data as part of ongoing evaluation of treatment and expect that you will attend to the data and give us your true appraisal of conditions. 

Caregiver Engagement and Participation

Providing effective treatment to families requires the establishment of a partnership between the child,  treatment staff, and caregivers.  This partnership involves many elements, including effective communication, mutual respect, clear boundaries, and clearly defined roles.  Although every treatment team member plays a role on the team, caregivers play a key role.  Parents/caregivers are the most important members of their child’s treatment team.  While treatment staff will come and go, caregivers remain the central axis of any treatment team. 

Caregiver Commitment: 

In order to ensure effective implementation of the treatment plan/programming, Cayman ABA requests the following commitments listed below. If attempts to correct issues regarding these commitments fail, services might be terminated.

• Active participation in training regarding the child’s programming.

• Adherence to the child’s treatment plan.

• Immediate communication via email (phone if necessary) with the Case Manager on your child's team if unsure about how to implement a program/protocols.

• Immediate communication via email (phone if necessary) with the Case Manager on your child's team from the parent/caregiver if there is a concern that a program/ protocol is not being implemented correctly or working effectively.

• Meeting with the BCBA on your child’s team at least once per month

Procedure for Lack of Participation:

1. The first time that a parent or guardian does not meet one of the participation requirements, a Supervisor will provide the parent or guardian with a verbal warning and follow up with an email reminding the parent or guardian of participation requirements. A Supervisor will explain clearly to the parent or guardian where their participation is lacking and provide training if needed.

2. The second time that a parent or guardian does not meet one of the participation requirements, a Supervisor will provide the parent or guardian with a written notice reminding the parent or guardian of the participation policy. The notice will clearly explain to the parent or guardian where their participation is lacking and a Supervisor will provide training if needed.

3. The third time that parent or guardian does not meet one of the participation requirements, a Supervisor will meet with the parent or guardian and provide them a final written notice reminding the parent or guardian of the participation policy. The notice will clearly explain to the parent or guardian where their participation is lacking. The Supervisor and Clinicians will work closely with the parent or guardian to provide the training necessary to correct the issue. Additionally, the notice will explain to the parent that if the parent or guardian does not meet the participation requirements again, the child's services will be discontinued.

4. The fourth time that a parent or guardian does not meet one of the participation requirements, the child's services will be discontinued due to lack of participation. The consultant will meet with the parent or guardian to explain to the parent where their participation is lacking. Services will be faded back according to a fade plan that will be individually determined for each child and referrals will be made if necessary and appropriate.

The clinical team will work closely with every parent or guardian in order to ensure that parent participation is as easy and enjoyable as possible for every parent or guardian. When issues do arise, the therapist will work closely with the parent or guardian to determine how to resolve the issue. When parents or guardians participate fully in their child's programming, they should see more progress from their child and have a better understanding of how to respond to various issues.

Parents/caregivers are expected to participate in treatment sessions as often as determined through the collaboration of the clinical team, which includes the clinicians involved in the child’s program and the parents.  Parents/caregivers will learn how to embed their child’s individual goals within the family’s daily routines.  Intervention plans will be communicated to parents/caregivers each session. As a provider, our partnership with the family is critically important to us, as we believe that this partnership is instrumental in the success of our clients. Failure for a parent/caregiver to engage in this partnership with us through the lack of their involvement in treatment sessions at the required level, as determined at the outset by collaboration between the caregiver and clinician, may result in concluding services. Additionally, we collaborate with parents and caregivers on a number of issues during intervention. These include how to set up the environment to best support the client’s learning, and how to limit access to items that may interfere with learning during a session. Your support and partnership with these issues will ensure the best success of treatment.

Location of Treatment and Treatment Policy

Across Cayman ABA, intervention may take place in the clinic, home, school and/or community environments.  The location of your child’s treatment program is dependent on the type of service(s) he/she receives.  A caregiver at least 18 years of age or older must be present during all sessions that take place in the home and community environments.  

Please note that your home serves not only as the location of intervention, but also as the working environment of our staff; as a result, all home-based sessions must occur in a clean and smoke-free environment. Additionally, all pets should be secured as needed during intervention so as not to disrupt intervention. If at any time our staff do not feel safe or comfortable, they will conclude the session and notify the office and their supervisor. During home sessions, a caregiver must be on the premises at all times.  During community sessions, a caregiver must be in line of sight at all times.  Parents/caregivers are expected to provide legal, appropriate parking for all staff attending home-based sessions.  

Recommendations for Services

Our clinicians are dedicated to providing your family with the appropriate level of recommended services.  In addition, they are trained to provide ongoing analysis of your child’s measurable goals in order to prescribe you and your family the correct number of therapy hours.  Cayman ABA takes this prescription for services very seriously. We are committed to providing you and your family with 100% of the recommended hours, as your child’s progress and outcome for services is directly linked to this factor.  Should these hours drop below the appropriate level, your clinical team will discuss with you the importance of maintaining the prescribed amount of hours weekly. Each child responds individually to the intervention process and each child learns at a different rate and in different ways.  Cayman ABA is dedicated to providing effective treatment, but cannot make guarantees regarding individual client progress or outcomes.

Psychological Assessment

Your Cayman ABA clinician may ask you to complete psychological and/or psychoeducational measures (e.g. questionnaires, behavior rating scales, personality measures, etc.) in order to inform diagnosis and treatment planning, make educational recommendations, and/or evaluate the outcome or efficacy of treatment. While outcomes from these measures will be discussed with you and integrated into the overall treatment plan, any assessment protocol can only be released to professionals/clinicians who are trained to interpret such information and will only be released to such an individual with your written consent. 

Scheduling of Clinical Services and Treatment

Your child’s schedule will be developed based on your child’s individual needs, funding source requirements, and the match between client and staff availability.  We request that families provide our team with the maximum amount of availability to optimize the service delivery process.  We recognise the challenges that come with balancing family needs and intervention services.  We will attempt to make the best possible scheduling arrangements for each child.  Flexibility by all individuals involved in your child’s treatment is appreciated and important.

In order to keep paper waste at a minimum, our team communicates new schedule announcements through email.  All parents and caregivers can access their schedules by logging in to their portal in CentralReach. If you cannot log in to CentralReach, please notify us immediately.  

We sincerely appreciate proactive forward planning from caregivers, in the form of communications to scheduling@caymanaba.com, when you know that your child’s schedule will be affected (e.g., conflicting doctor’s appointments, vacations, plans to continue services, school closures, etc). Any same-day or last-minute schedule changes initiated by Cayman ABA will be communicated directly to you via Phone Call or WhatsApp messaging.  

Client Attendance and Cancelation Policy

One of the most critical aspects to intervention is consistency of implementation. In the same way that pharmaceutical prescriptions are only effective if taken in the manner prescribed, the same is true for intervention services. Please make every attempt to keep your child’s scheduled appointment.

• Your child will benefit the most from our services if he/she attends 100% of the scheduled appointments.

• Attendance must be 80% or greater for regularly scheduled appointments within a two-month period. (Does not include sessions cancelled due to holidays)

• Sessions cancelled with less than a 24-hour notice are defined as cancellation with insufficient notice.

• For clinic-based services your child may be discharged after the third no show.

*Please note that a 24-hour cancellation notice is required, or a full session may be charged.

Definition of Cancellation with Insufficient Notice

Notifying Cayman ABA of a child’s cancellation less than 24 hours in advance is considered insufficient notice. Families are given two cancellations with insufficient notice before they are charged.  On the third instance of cancellation with less than 24-hour notice, the full session rate will be charged.  

Definition of Cancellation due to Illness

When your child is sick, please notify Cayman ABA no later than 2 hours before the scheduled session start time, to cancel the session(s) scheduled for that day.  You will not be charged for your session that day, and this does not count as insufficient notice.  However, you should also indicate if your child will need to cancel for the following days, so you do not incur a Cancellation with Insufficient Notice on the next consecutive day your child is sick.  

Definition of Running Late

If for any reason you are running late for a session, please notify the Clinical Operations Supervisor via phone call 345-926-1643 as soon as you know you will be late. If no contact is made, the session will be cancelled 15 minutes after the scheduled appointment.  If you contact our scheduling department to notify, the therapist will wait up to 30 minutes.  Please note your full session may not be met because other clients may be scheduled after your session.   You will be billed CI$30.00 for late arrivals 7 minutes past the scheduled session start time; please note that this is not billable to insurance, and you will be billed directly. 

Definition of No-Show

Failure to call Cayman ABA to cancel a session or calling after a session was scheduled to begin and/or cancelling a session less than two hours in advance.

Staff Cancellations

Please be aware that we will make every effort to ensure that your child receives intervention during their original scheduled time.  A substitute staff may be provided in the event that one of our team members is absent, or a make-up session may be scheduled.  In the event that your child's session will be cancelled or rescheduled by Cayman ABA, you will be contacted. If the therapist assigned to the session is running more than 15 minutes late you will be contacted as soon as possible. The therapist may stay later than scheduled to make up the time missed or make time up on another day. You will only be charged for the time we work with your child.  Please notify managers of excessive staff tardiness. We may need to re-evaluate schedules (re: drive time, traffic, time of day, etc.).

Vacation

Families must notify Cayman ABA of their vacation plans (planned absences of 3 days or more) at least two weeks prior to their scheduled vacation.  Failure to notify us with this amount of notice may result in your child losing their standard scheduled slots upon return.

*Continued rates of cancelation in excess of 20% of scheduled sessions (less than 80% attendance within a two-month period) may result in termination of services based on our inability to guarantee clinical integrity in the services being provided.

Wellness Policy 

To minimize the spread of illness, Cayman ABA wellness policy requires that a session be cancelled and rescheduled if the client or Cayman ABA staff displays one or more of the following symptoms and guidelines listed below. Additionally, all policies relating to child wellness are outlined in detail in our Facility Health Policies. 

The client or staff must be free of infection and other symptoms, without the aid of medication, for 24 hours before resuming program sessions. Sessions may resume when the incubation and contagious period is passed and the client or staff is well enough to resume normal activities. If the client or staff becomes ill during a session, the session will be immediately canceled.

• Vomiting/Diarrhea

• Temperature greater than 100 degrees fahrenheit

• Respiratory problems - severe coughing, rapid breathing, croup, or whooping sound after coughing

• Thick discolored discharge from nose

• Rash or infection of the skin (e.g., ringworm, poison ivy)

• Evidence of lice, including nits

• Communicable diseases - Conjunctivitis (pink eye), influenza, measles, chicken pox, strep throat, etc.

Parents acknowledge that if their child exhibits any of the symptoms outlined above and in our Facility Health Policies, they should contact the staff at Cayman ABA to cancel and reschedule their child's session. If for any reason your child did not attend school due to an illness or was sent home early due to an illness, there should be no therapy session that day. Parents agree to notify the staff within 24 hours of the diagnosis of a serious contagious illness or parasitic infestation. Parents acknowledge that in some instances sessions will be cancelled until we have written permission from a doctor saying their child is well enough to resume therapy sessions. This is for the child's well-being along with the well-being of the staff.

Please notify the Clinical Operations Supervisor of any illness that your child, you, or other children in the home may have. We will also contact you if any therapist has any illnesses. In the case that your child's session will be cancelled due to illness of a staff member you will be contacted immediately.

Please note: Our staff will use their best judgment, as well as the guidelines set forth in the Facility Health Policies, to determine when to send children home (24-hour cancellation fees do not apply).

Inclement Weather Policies and Procedures

The following statements pertain to the policies and procedures regarding appointments and or travel during inclement weather.  Inclement weather is defined as weather that has the potential to cause injury or harm if and when traveled in.  Examples of inclement weather can take many forms and can include, but should not be limited to the following:

• Flash flood warnings, or flooded areas

• Excessively high temperatures, or high heat index

• Poor air quality warnings

• Severe thunderstorm warnings, hurricane warnings or sightings for a related area.

Decisions regarding the weather and/or safety risks shall be made by the Cayman ABA staff from the agency's standpoint. However, the client has the right to reschedule appointments if there is a reasonable risk to safety as opposed to an attempt to merely cancel the appointment. If the staff believes that the weather presents a reasonable risk to the health and safety of the client or staff, any scheduled appointments, to include home visits, planned trips, etc., shall be rescheduled. In the event of a need to reschedule an appointment, the staff shall notify the client as soon as possible by means outlined between the staff and client during the initial stages of the case (phone/email). It should be the understanding of the client that inclement weather and the dangers presented as a result of it can, and will, include areas that lead to the client's home or location of the planned trip. Safe conditions at the client's place, residence, or at the location of the planned trip does not exclude the dangers present in the areas that must be traveled in order to reach these destinations.

Parents acknowledge that it is their responsibility to provide viable contact information, which would include a method of contacting the client in the event of an emergency type situation.

In most circumstances, the Cayman ABA staff will follow the local school cancellations for the area in which you or the staff resides. If the staff believes they are able to continue with the scheduled appointment, they will notify you to confirm the session. Sessions are difficult to reschedule given the times families are available, however the staff will make all efforts to make accommodations. Please keep in mind that other regular scheduled appointments may interfere with rescheduling on another day.  

Video Recording Policy and Consent

As a part of our clinical practice, sessions may be video recorded or available for viewing via a live stream camera, which is available for viewing only by Cayman ABA staff.  These recording(s) will be used for clinical review of client progress, as well as ongoing supervision. The recordings will be the property of Cayman ABA, and may be stored as a part of the client record.

The parent/caregiver may consent for video recordings to be used for additional purposes such as educational and training resources to be used within and outside of the company. However, if the parent/caregiver objects to allow the use of video recordings for educational and training purposes, it will in no way jeopardize their relationship with Cayman ABA.

The parent/caregiver may consent for video recordings to be used for additional purposes such as educational and training resources to be used within and outside of the company. However, if the parent/caregiver objects to allow the use of video recordings for educational and training purposes, it will in no way jeopardize their relationship with Cayman ABA.

Observation Consent

Cayman ABA shall not allow, without the written specific consent of the affected client’s, legal guardian observation of any client by persons other than parents of current or prospective clients, paid staff, authorized tours (e.g., intakes, graduate student programs), current clients, volunteers and student interns working in the clinic, authorized staff or authorized Governmental monitoring personnel.   

Publicity Consent

The legal guardian may consent for photographs of their child to be used for additional purposes such as marketing and publicity. However, if the legal guardian objects to allow the use of photographs for publicity purposes, it will in no way jeopardize their relationship with Cayman ABA. 

Assignment of Staff

Cayman ABA stands by the level of training and expertise of its entire staff. All staff assigned to provide care to your child and family have been trained to extend high customer service and to provide quality care within our professional boundaries. Cayman ABA reserves the right to change staff servicing your family to best meet the needs of the client, the requirements of your funding agency, or in compliance with Human Resource requirements. All clients will be made aware of permanent changes in staff in advance whenever possible; however please note that occasionally situations arise in which advance notice may not be provided. We are not always able to guarantee specific staff. 

Additionally, Cayman ABA is a training facility and a range of professionals may include interns, clinical fellows, students in a clinical practicum, or new employees in a training program, some of whom provide services.  All professionals-in-training are supervised by licensed professionals. Cayman ABA is a training site for various clinical disciplines. Please note that therapy sessions may occasionally include additional staff members for training purposes. Any concerns regarding staff should be immediately discussed with the clinician supervising your child’s treatment. 

Professional Boundaries

We truly value the relationships we develop with our clients and families.  It is through these collaborative and cooperative relationships that we are able to work as a team.  In order to maintain healthy, professional relationships with our clients and families, we adhere to the following:

• If you need to communicate with one of our staff members, please call the main office unless other arrangements have been made (e.g., a cell phone number or group chat has been provided) with the specific service provider. 

• It is our responsibility to ensure confidentiality at all times.  While in the office, please remain in the waiting room unless a staff member directs you to a specific room, or you are going directly to speak with one of the office staff.  

• We want to maximize our time with the child, so communication between staff and caregivers should be kept on topic and take place at appropriate times during a session (e.g., beginning and/or end).

• We value balance between work and personal lives.  Calls should be placed and returned during normal business hours.

• Direct Service Providers help carry out treatment goals developed by all clinical disciplines.  Their time is very valuable and they need to be focused on working with your child, so we ask that any questions that are clinical in nature (e.g., how is my child progressing) are directed to clinicians on your team (Psychologist, Counselor or BCBA)

• We ask our team members to arrive on time as well as leave on time so that everyone is able to stay on schedule.

• After a session is complete, team members will properly clean up the area(s) in which they are working.

Legal Consent

Decisions about psychological, medical, behavioural, developmental and/or educational care must be made by the child’s legal guardian(s), who must be physically present to provide consent, have an opportunity to be fully informed of Cayman ABA’s service process, be provided with an opportunity to ask questions, and in order for identity to be verified. In the event of a parental separation or divorce, both parents MUST consent, in writing, to engage in Cayman ABA’s services. Both parents are invited and encouraged (as they are able) to participate in Cayman ABA’s service delivery process.  If one parent retains sole legal custody, this parent MUST provide legal documentation of this in order for Cayman ABA’s services to be provided. In the case of joint custody, both parents MUST consent if there is definite interest in engaging Cayman ABA’s services. Both parents, regardless of custody, have a legal right to records.

Assessment and Treatment of Children of Separated or Divorced Parents

In the treatment of children whose parents are separated or divorced, a number of issues can arise. By signing this document, you confirm that you understand and are in agreement with the following policies:

• Each parent will be offered equal time with Cayman ABA staff regardless of which parent initially contacts Cayman ABA. A signed release of information will need to be obtained from the custodial parent in order to share information with the non-custodial parent.

• Exceptions to these policies include but are not limited to: when a parent lives outside of the Cayman Islands; is incarcerated; has a restraining order in place against him/her; has limited to rare contact with the child/family; and/or does not have legal authority to make decisions regarding development-related services and/or mental health services for the child (or as specified in court documentation). Cayman ABA is available to consult by phone with parents who live out of state, and these sessions will be billed at our standard fee for Telehealth services.

Please provide Cayman ABA with a copy of the section within your divorce decree and/or court order that specifies legal custody agreement.

Ideally, consent for clinical services and/or treatment for the child should be provided by all legal guardians. Rare exceptions are clinically determined case by case or if mandated by court documentation. In addition, information provided by one parent or legal guardian may be shared with the other parent or legal guardians in order to facilitate services/treatment, as clinically warranted, or as mandated by court documentation.

Legal Matters

In legal disputes, particularly between parents, psychologists are sometimes asked to release information such as detailed treatment records, testing protocol, and/or to testify in Court. Releasing this information can be detrimental to a child’s well-being, especially if used against the child’s other parent; as such, this breaches a psychologist’s ethical mandate to do no harm. Cayman ABA asks that you do not seek records with the goal of utilizing the information in a legal or domestic dispute. 

Requests for access to the client’s case record(s) maintained by Cayman ABA and/or for Cayman ABA clinicians to legally testify regarding any and all aspects of services delivered on behalf of the client will only occur where required by law (i.e., a court order or subpoena). In addition, Cayman ABA will not make recommendations towards and/or participate in the process of determining child visitation or child custody. Cayman ABA does not employ forensic psychologists who are trained in that type of evaluation. Therefore, Cayman ABA clinicians will not communicate with attorneys for either parent or with any professional within the legal system about visitation or custody. 

Parent Interactions with staff and Dual relationships

The nature of our business can often be personal because we are all working so intensely with each other on a frequent basis.  For this reason, we mandate that parents maintain a friendly relationship with staff members but not a personal relationship. Parents acknowledge that any relationship outside the clinical service or therapeutic service is completely inappropriate.

Under the code of ethical conduct for clinical services and behavior analysts, we are not allowed to work with you in any other capacity except as your consultant or behavior therapist. If Cayman ABA staff work in your home with your child, it is not appropriate for you to leave the premises at any time or to ask our staff to take your child to some other location that is not directly related to our services.

A dual relationship is any time two people have more than one relationship (for example: an RBT attends the same gym as their client’s parent). Cayman ABA staff are trained to never engage in any dual relationship with clients that can be exploitative or sexual in nature, and to discuss dual relationships as they arise with their clinician or with the Clinical Manager.  It is important to acknowledge that multiple relationships are not always unethical, avoidable, or unexpected. Rather, they are fairly common, especially in small communities such as the one we live in. We will assess the risks carefully before entering into any dual relationships with clients and their families. We encourage families to consider any risks to the client and family before engaging in dual relationships with those they have a current or former professional relationship with. 

Dual relationships include, but are not limited to, babysitting, acting as the nanny, bartering of services of goods, friendships, sexual relationships, etc. This pertains to past and present employees. Cayman ABA staff are not permitted to engage in these types of dual relationships.

Cayman ABA strives to hire the best; however, at times people may leave our company for various reasons. In those instances, we also do not encourage families to hire or have dual relationships with our past or present staff members. Due to the confidentiality we hold with our staff members and parents, we cannot go into detail on why a staff member left the company. This is for the protection of Cayman ABA and for our clients.

Parents acknowledge that Cayman ABA does not ever allow employees to transport clients or client family members.

Gift Giving Policy

We really appreciate that a family, at times, especially over the holidays, like to express their gratitude for the staff that provide services to their family through gift giving. However, per our professional codes of conduct, all employed staff and all trainees are not able to accept gifts including store gift cards, food, clothing, tickets to events, housing, access to vehicles and other tangible items. Please feel free to have your child express their gratitude in other ways, such as cards, donations to charities, etc.

Discharge Criteria

Individuals who exit Cayman ABA’s program, leave for a variety of reasons; which range from conflicting schedules and goals to completion of services. Cayman ABA considers a variety of factors (including a review of the client’s treatment data) when determining whether a discharge from services may be appropriate.  The following instances may warrant a discharge from Cayman ABA intervention services.  A detailed list follows:

• Complete outcome of service: The client’s referred excesses and deficits have been addressed and remediated. All problem behaviors identified at entry of service have been addressed and are exhibited within typical ranges. The child is functioning within normal limits for his or her age and demonstrates evidence that he/she will continue to acquire new skills under natural, non-therapeutic conditions.

  • May also include age appropriate ranges of development on standardized testing in the areas of diagnostic criteria, cognition, language (basic speech and language as well as a pragmatic language), social problem solving, executive functioning, and adaptive skill functioning.

  • The client has met his long-term goals and objectives and there is no need to develop new ones.

• Services are deemed no longer appropriate due to minimal progress over a substantial period of time.

  • There has been no reasonable improvement in 3 months and it has been determined that further improvement is unlikely with continuation of treatment.

• Family's decision to terminate, due to various reasons including disagreement regarding the child's program.

• Failure to comply with Cayman ABA policies and procedures as outlined in our Client handbook.

  • The client has 3 documented, un-notified (“no show”) cancellations for clinic-based services within a two-month period.

  • The client has 3 documented, un-notified (“late”) arrivals for clinic-based services within a two-month period, without at least a 24-hour notification.

  • Continued rates of cancellations by families in excess of 20% of the child’s scheduled hours.

  • A documented willful lack of participation in treatment by the parents, as determined through a consultative case review by the child’s service team.

• The client’s needs are such that they cannot be adequately addressed by Cayman ABA clinical staff. 

  • In such cases, Cayman ABA will contact the appropriate agency and assist in finding an appropriate program for the child.

• The funding agency terminates funding of the child’s program and there is no alternative payment method available.

• Failure to make payment for invoices within 30 days.

Grievance Procedure

At Cayman ABA, we make every effort to ensure that our staff are caring, respectful and partnering with our clients and their families. We encourage the client to discuss any matter of concern regarding the services delivered by Cayman ABA staff with the BCBA or the psychologist (respectively) assigned to the case for the purpose of resolving a concern. 

Early and immediate resolution of concerns and conflicts is strongly encouraged, and a meeting may be scheduled with the client, staff member, BCBA/ psychologist, and the designated management staff to assist in reaching a satisfactory resolution.

We recognize that at times our families and clients will need to provide us with feedback concerning our staff. As appropriate, please follow this grievance procedure:

1. STEP ONE: Please communicate with your child’s assigned Clinical Supervisor / Clinician (if applicable) about any concerns pertaining to the direct service provider, clinical program, or other initial concerns.  In the event there is not a satisfactory resolution reached with the Clinical Supervisor / Clinician, the client may appeal the matter to the Clinical Manager, or if you have concerns about the Clinical Supervisor / Clinician, please proceed to STEP TWO.  Note that it is ALWAYS the client’s right to refuse services at any time; this needs to be communicated in writing to the Clinical Manager (anoush@caymanaba.com) if consent for services is revoked.

2. STEP TWO: Please communicate with the Clinical Manager about any concerns about your Clinical Supervisor or about any concerns that you have elevated to the Clinical Supervisor / Clinician that have not been addressed adequately. 

3. STEP THREE: If you feel like the issue/concern has not been resolved, please fill out a formal complaint at http://www.caymanaba.com/complaints.  Within two (2) business days of receipt of a written complaint (via email, website submission, letter or the Client Complaint Form), the company’s Director(s) will respond.

4. STEP FOUR: If the client is still not satisfied, they have the right to refuse services, contact their insurance company/case manager (if applicable) or contact the Cayman Islands Health Practice Commission:
   

Health Practice Commission
3nd Floor, Government Administration Building, 133 Elgin Avenue
Box 132 Grand Cayman KY1-9000, CAYMAN ISLANDS
Telephone: (345) 949 -2813 / 946 -2084, Fax: (345) 946 -2845

Policies for PSYCHOLOGICAL AND COUNSELING Services

Scope(s) of Practice

Psychology: Psychologists are ethically bound to practise within their scope of practice and in accordance with their area(s) and level of expertise.  Psychologists diagnose mental health conditions, and are bound by the APA Ethics Code. A psychologist may work within a scope of practice, only if they are demonstrably competent to do so, or are doing so under appropriate supervision (for example when training in a new area of practice).

Psychotherapy

Therapy is a relationship between people that works in part because of clearly defined rights and responsibilities held by each person. As a client in psychotherapy, you and/or your child have certain rights and responsibilities that are important for you to understand. There are also legal limitations to those rights that you should be aware of.  Cayman ABA staff, as your therapist, have corresponding responsibilities to you. These rights and responsibilities are described in the following sections.

Psychotherapy has both benefits and risks. Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration, loneliness and helplessness, because the process of psychotherapy often requires discussing the unpleasant aspects of your life.  However, psychotherapy has been shown to have benefits for individuals who undertake it.  Therapy often leads to a significant reduction in feelings of distress, increased satisfaction in interpersonal relationships, greater personal awareness and insight, increased skills for managing stress and resolutions to specific problems.  But, there are no guarantees about what will happen.  Psychotherapy requires a very active effort on your part. In order to be most successful, you will have to work on things we discuss outside of sessions.

The first 2-4 sessions will involve a comprehensive evaluation of your needs. By the end of the evaluation, your clinician will be able to offer you some initial impressions of what your therapy program might include. At that point, your clinician will discuss your treatment goals with you and create an initial treatment plan. You should evaluate this information and make your own assessment about whether you feel comfortable working with your clinician.  If you have questions about your clinician’s procedures, please bring them to your clinician’s attention whenever they arise. If your doubts persist, your clinician will be happy to help you set up a meeting with another mental health professional for a second opinion.

Appointments

Appointments will ordinarily be 50 minutes in duration, at a frequency and time you and your clinician agree on, although some sessions may be longer or shorter depending on your specific needs. The time scheduled for your appointment is assigned to you and you alone. If you need to cancel or reschedule a session, we require 24 hours notice.  Please read our cancellation policy under the Financial Responsibility Agreement for a complete description of our policy and fees associated with cancellations and/or no-shows.

Professional Records

Our clinicians are required to keep appropriate records of the psychological services that they provide. Your records are maintained in a secure online medical records software system. Our clinicians keep brief records noting that you were here, your reasons for seeking therapy, the goals and progress we set for treatment, your diagnosis, topics we discussed, your medical, social, and treatment history, records I receive from other providers, copies of records I send to others, and your billing records. Except in unusual circumstances that involve danger to yourself, you have the right to a copy of your file. Because these are professional records, they may be misinterpreted and / or upsetting to untrained readers.  For this reason, we recommend that you initially review them with your clinician, or have them forwarded to another mental health professional to discuss the contents. If your clinician refuses your request for access to your records, you have a right to have that decision reviewed by another mental health professional, which your clinician will discuss with you upon your request. You also have the right to request that a copy of your file be made available to any other health care provider at your written request.

Confidentiality

Our policies about confidentiality, as well as other information about your privacy rights, are fully described in our Confidentiality and Privacy Practices.  Your signature on this document confirms that you have been provided with a copy of this document and understand the limits to confidentiality set forth under the law.  You confirm that you have discussed any issues or questions about our privacy practices with your clinician.  Please remember that you may reopen the conversation at any time during your work with Cayman ABA staff.

Contacting Your Clinician

Our clinicians are not often not immediately available by telephone. They do not answer their phones when with clients or otherwise unavailable. At these times, you may leave a message on their confidential voicemail and your call will be returned as soon as possible; however, it may take a day or two for non-urgent matters. If, for any number of unseen reasons, you do not hear from your clinician or your clinician is unable to reach you, and you feel you cannot wait for a return call or if you feel unable to keep yourself safe, 

1. go to your Local Hospital Emergency Room, or 

2. call 911 and ask to speak to the mental health worker on call. 

Your clinician will make every attempt to inform you in advance of planned absences, and provide you with the name and phone number of the mental health professional on our team that can support you in your clinician’s absence.

Psychological Assessment

Your Cayman ABA clinician may ask you to complete psychological and/or psychoeducational measures (e.g. questionnaires, behavior rating scales, personality measures, etc.) in order to inform diagnosis and treatment planning, make educational recommendations, and/or evaluate the outcome or efficacy of treatment. While outcomes from these measures will be discussed with you and integrated into the overall treatment plan, any assessment protocol can only be released to professionals/clinicians who are trained to interpret such information and will only be released to such an individual with your written consent. 

Scheduling of Clinical Services and Treatment

Your child’s schedule will be developed based on your child’s individual needs, funding source requirements, and the match between client and staff availability.  We request that families provide our team with the maximum amount of availability to optimize the service delivery process.  We recognise the challenges that come with balancing family needs and intervention services.  We will attempt to make the best possible scheduling arrangements for each child.  Flexibility by all individuals involved in your child’s treatment is appreciated and important.

In order to keep paper waste at a minimum, our team communicates new schedule announcements through email.  All parents and caregivers can access their schedules by logging in to their portal in CentralReach. If you cannot log in to CentralReach, please notify us immediately.  

We sincerely appreciate proactive forward planning from caregivers, in the form of communications to scheduling@caymanaba.com, when you know that your child’s schedule will be affected (e.g., conflicting doctor’s appointments, vacations, plans to continue services, school closures, etc). Any same-day or last-minute schedule changes initiated by Cayman ABA will be communicated directly to you via Phone Call or WhatsApp messaging.  Assessment and Treatment of Children of Separated or Divorced Parents

In the treatment of children whose parents are separated or divorced, a number of issues can arise. By signing this document, you confirm that you understand and are in agreement with the following policies:

• Each parent will be offered equal time with Cayman ABA staff regardless of which parent initially contacts Cayman ABA. A signed release of information will need to be obtained from the custodial parent in order to share information with the non-custodial parent.

• Exceptions to these policies include but are not limited to: when a parent lives outside of the Cayman Islands; is incarcerated; has a restraining order in place against him/her; has limited to rare contact with the child/family; and/or does not have legal authority to make decisions regarding development-related services and/or mental health services for the child (or as specified in court documentation). Cayman ABA is available to consult by phone with parents who live out of state, and these sessions will be billed at our standard fee for Telehealth services.

Please provide Cayman ABA with a copy of the section within your divorce decree and/or court order that specifies legal custody agreement.

Ideally, consent for clinical services and/or treatment for the child should be provided by all legal guardians. Rare exceptions are clinically determined case by case or if mandated by court documentation. In addition, information provided by one parent or legal guardian may be shared with the other parent or legal guardians in order to facilitate services/treatment, as clinically warranted, or as mandated by court documentation.

Legal Matters

In legal disputes, particularly between parents, psychologists are sometimes asked to release information such as detailed treatment records, testing protocol, and/or to testify in Court. Releasing this information can be detrimental to a child’s well-being, especially if used against the child’s other parent; as such, this breaches a psychologist’s ethical mandate to do no harm. Cayman ABA asks that you do not seek records with the goal of utilizing the information in a legal or domestic dispute. 

Requests for access to the client’s case record(s) maintained by Cayman ABA and/or for Cayman ABA clinicians to legally testify regarding any and all aspects of services delivered on behalf of the client will only occur where required by law (i.e., a court order or subpoena). In addition, Cayman ABA will not make recommendations towards and/or participate in the process of determining child visitation or child custody. Cayman ABA does not employ forensic psychologists who are trained in that type of evaluation. Therefore, Cayman ABA clinicians will not communicate with attorneys for either parent or with any professional within the legal system about visitation or custody. 

Parent Interactions with staff and Dual relationships

The nature of our business can often be personal because we are all working so intensely with each other on a frequent basis.  For this reason, we mandate that parents maintain a friendly relationship with staff members but not a personal relationship. Parents acknowledge that any relationship outside the clinical service or therapeutic service is completely inappropriate.

Under the code of ethical conduct for clinical services and behavior analysts, we are not allowed to work with you in any other capacity except as your consultant or behavior therapist. If Cayman ABA staff work in your home with your child, it is not appropriate for you to leave the premises at any time or to ask our staff to take your child to some other location that is not directly related to our services.

A dual relationship is any time two people have more than one relationship (for example: an RBT attends the same gym as their client’s parent). Cayman ABA staff are trained to never engage in any dual relationship with clients that can be exploitative or sexual in nature, and to discuss dual relationships as they arise with their clinician or with the Clinical Manager.  It is important to acknowledge that multiple relationships are not always unethical, avoidable, or unexpected. Rather, they are fairly common, especially in small communities such as the one we live in. We will assess the risks carefully before entering into any dual relationships with clients and their families. We encourage families to consider any risks to the client and family before engaging in dual relationships with those they have a current or former professional relationship with. 

Dual relationships include, but are not limited to, babysitting, acting as the nanny, bartering of services of goods, friendships, sexual relationships, etc. This pertains to past and present employees. Cayman ABA staff are not permitted to engage in these types of dual relationships.

Cayman ABA strives to hire the best; however, at times people may leave our company for various reasons. In those instances, we also do not encourage families to hire or have dual relationships with our past or present staff members. Due to the confidentiality we hold with our staff members and parents, we cannot go into detail on why a staff member left the company. This is for the protection of Cayman ABA and for our clients.

Parents acknowledge that Cayman ABA does not ever allow employees to transport clients or client family members.

Gift Giving Policy

We really appreciate that a family, at times, especially over the holidays, like to express their gratitude for the staff that provide services to their family through gift giving. However, per our professional codes of conduct, all employed staff and all trainees are not able to accept gifts including store gift cards, food, clothing, tickets to events, housing, access to vehicles and other tangible items. Please feel free to have your child express their gratitude in other ways, such as cards, donations to charities, etc.

Discharge Criteria

Individuals who exit Cayman ABA’s program, leave for a variety of reasons; which range from conflicting schedules and goals to completion of services. Cayman ABA considers a variety of factors (including a review of the client’s treatment data) when determining whether a discharge from services may be appropriate.  The following instances may warrant a discharge from Cayman ABA intervention services.  A detailed list follows:

• Complete outcome of service: The client’s referred excesses and deficits have been addressed and remediated. All problem behaviors identified at entry of service have been addressed and are exhibited within typical ranges. The child is functioning within normal limits for his or her age and demonstrates evidence that he/she will continue to acquire new skills under natural, non-therapeutic conditions.

  • May also include age appropriate ranges of development on standardized testing in the areas of diagnostic criteria, cognition, language (basic speech and language as well as a pragmatic language), social problem solving, executive functioning, and adaptive skill functioning.

  • The client has met his long-term goals and objectives and there is no need to develop new ones.

• Services are deemed no longer appropriate due to minimal progress over a substantial period of time.

  • There has been no reasonable improvement in 3 months and it has been determined that further improvement is unlikely with continuation of treatment.

• Family's decision to terminate, due to various reasons including disagreement regarding the child's program.

• Failure to comply with Cayman ABA policies and procedures as outlined in our Client handbook.

  • The client has 3 documented, un-notified (“no show”) cancellations for clinic-based services within a two-month period.

  • The client has 3 documented, un-notified (“late”) arrivals for clinic-based services within a two-month period, without at least a 24-hour notification.

  • Continued rates of cancellations by families in excess of 20% of the child’s scheduled hours.

  • A documented willful lack of participation in treatment by the parents, as determined through a consultative case review by the child’s service team.

• The client’s needs are such that they cannot be adequately addressed by Cayman ABA clinical staff. 

  • In such cases, Cayman ABA will contact the appropriate agency and assist in finding an appropriate program for the child.

• The funding agency terminates funding of the child’s program and there is no alternative payment method available.

• Failure to make payment for invoices within 30 days.

Cayman ABA may DISCONTINUE your treatment for any of the following reasons:

1. Achievement of treatment goals.

2. Failure to appear for two or more appointments within a two-month period, without at least a 24-hour notification. 

3. Being consistently late for appointments or consistently cancelling appointments.

4. Not participating in treatment when requested.

5. Outstanding invoices over 30 days. 

If you are unhappy with what is happening in therapy, we hope you will talk with your clinician so that they can respond to your concerns. Such comments will be taken seriously and handled with care and respect. You may also request that your clinician refer you to another therapist and are free to end therapy at any time. You have the right to considerate, safe and respectful care, without discrimination as to race, ethnicity, color, gender, sexual orientation, age, religion, national origin, or source of payment. You have the right to ask questions about any aspects of therapy and about your clinician’s specific training and experience. You have the right to expect that your clinician will not have social or sexual relationships with clients or with former clients.

FINANCIAL RESPONSIBILITY POLICIES

During the term of this agreement, Cayman ABA will provide a range of behavioral health services and the parents/guardians/client will compensate Cayman ABA a payment for the services as described below on the terms and conditions specified:

Billing Policy

Cayman ABA bills clients and/or insurance providers on behalf of clients for any services rendered.  We do not bill or accept payment for future services.  

All payments are due by the due date listed on the invoice or in the statement emailed after the insurance payment has been received. Please see the information below regarding the payments.  Any disputes regarding billing information must be brought to the attention of the Accounts Department at the time the invoice has been received. Please email accounts@caymanaba.com with any questions.  Statements will also be sent monthly for all outstanding accounts at that time.  

A late charge of CI 50.00 will be added to accounts whose payments aren't received by the due date listed on the invoice or in the statement emailed after an insurance payment has been received. 

Finance charges of 10% per month, will accrue on the unpaid balance over 6 months and these charges will be included in the payment in full. Should your client account exceed 60 calendar days without any insurance payment, you agree to pay your account in full or request a meeting with the Operations Manager of Cayman ABA to negotiate a payment plan. The total payment amount due will be determined at that requested meeting.

Insurance Coverage

If you have insurance coverage and wish to use it, you should contact your insurance representative to obtain coverage information. The insurance contract is between the policyholder (you) and the insurance company, and not between the service provider (i.e., Cayman ABA) and insurer.   Cayman ABA will assist you by submitting claims electronically for each session, and will likely call your insurance company to double-check your benefits. 

It is important that you are familiar with your insurance coverage.  If a physician’s referral is required by your insurance plan, you are responsible to request and provide the referral prior to the first session. Insurance plans often require pre-authorization for services, and occasionally there is a limit on the number of visits allowed or an annual monetary cap.  It is the parents’ responsibility to secure needed information regarding their insurance coverage prior to beginning treatment. A copy of your insurance card and this packet are required prior to service. You are responsible for completing the appropriate insurance form before beginning services with Cayman ABA (assessment and/or treatment).  Once your benefits have been confirmed, it is recommended that you monitor the number of sessions you have had in relation to the number of sessions or amount of coverage allowed. If maximum insurance benefits are met, you are responsible for any outstanding Cayman ABA service charges.

Some services may not be covered under the mental health benefit of your insurance contract. Those services which you have requested, and which are not a covered benefit, will be billed directly to you.

Insurance companies require a diagnosis code to be submitted on the claim form for all services claimed.  As such, the primary client will be given a diagnosis, in order to establish the medical necessity of therapy. 

PLEASE NOTE:  As noted by insurance companies, verification of insurance benefits does not guarantee payment.  Clients are ultimately responsible for all financial fees incurred.

Self-Pay

An account is determined to be Self-Pay if: 

• There is no insurance carrier on record. 

• All expected payments from the insurance carriers have been paid. 

• The insurance policy benefits for a client have been met or maximized.

• Insurance carrier has denied coverage for services or indicates that services are not covered under the plan.

• A client has not responded timely to requests for information/documentation needed to determine eligibility with third party payers.

• A client does not provide information requested from third party insurers to process claims.

Payment Plans

Payment plans are available for self-pay accounts, in scenarios where circumstances make it difficult for clients to settle self-pay accounts on time.  The client is expected to email accounts@caymanaba.com to request an individualized payment plan, so that this can be arranged and agreed.  Once a payment plan is established, the client is expected to meet the payments on time.  If payments are not made according to the schedule stipulated in the payment plan, the Self-Pay account will be sent to an external collections agency for collections after 60 days of non-payment.

Cancellation Policy

Once an appointment is scheduled, you will be expected to pay for it unless you provide 24 hours advance notice of cancellation (by phone call or email), or unless Cayman ABA and yourself both agree that you were unable to attend due to circumstances beyond your control. When cancellations occur, Cayman ABA will either find another time to reschedule the appointment or resume with the next regularly scheduled appointment time. Since insurance companies do not typically pay for cancelled appointments, you will be required to pay the full cost of the appointment (see “Fees for Services” section below) and your insurance company will not be billed; payment for cancelled appointments will be considered self-pay charges.

• Cancellation with less than 24-hours notice: Notifying Cayman ABA of a child’s cancellation less than 24 hours in advance is considered insufficient notice. Families are given two cancellations with insufficient notice before they are charged.  On the third instance of cancellation with less than 24-hour notice, the full session rate will be charged.  

• Late arrival: You will be billed CI$20.00 for late arrivals 10 minutes past the scheduled session start time; please note that this is not billable to insurance, and you will be billed directly. 

• Late pickup:  We understand that traffic is often a barrier locally; however, it is important that you allow enough time to ensure that you pick up your child on time, because our therapists have other sessions scheduled directly after their sessions. You will be billed CI$20.00 for late pickups 10 minutes past the scheduled session start time; please note that this is not billable to insurance, and you will be billed directly. This is considered “respite care,” which is supervised play time between sessions or after sessions (see “Fees for Services” section below).

• No Show: Failure to call Cayman ABA to cancel a session or cancelling a session less than two hours in advance, and/or calling after a session was scheduled to begin.  Families are allowed one no-show before they are charged.  On the second instance of a no-show, the full session rate will be charged.  

Methods of Payment

Payments for sessions or insurance co-payments can be made by check, cash, Butterfield Bank Bill Pay or online domestic or wire transfer.

1. Cheques: Please make checks payable to Cayman ABA. 

   1. A CI 50.00 charge will be incurred for any returned checks; it will be your responsibility to pay the outstanding amount plus this charge fee either online or with a draft within three business days.

2. Butterfield Bill Pay: Payments can be made online to Cayman ABA through Butterfield Bank’s online Bill Pay system. 

3. Domestic Transfer: Payments can be made online as a domestic transfer through your local bank, to Cayman ABA’s Bank of Butterfield account.  Account details will be listed on your invoice.

4. NO Cash: please note that Cayman ABA staff members do not accept cash.

Collection Notices

Cayman ABA will seek payment for any services our staff have rendered. When a balance is owed by the client, the payment is considered “Self-Pay” and payment in full is expected at the time the invoice is generated and sent.  Payment is expected upon receipt, and a grace period of no more than two-months (60 days) is given for families.  Cayman ABA reserves the right to utilize external vendors to assist the company regarding client balances due, processing client payment plans, and/or other methods to reconcile client accounts.

Outside Collection Agencies 

Cayman ABA contracts with external collection agencies to assist in the collection of certain accounts, including all payment amounts that the client is responsible for that have not been resolved after issuance of final notices on outstanding invoices.   Any accounts overdue past 60-days, without a payment plan in place, will be sent to external collections agencies.  If it becomes necessary for third party collection, the client hereby agrees to pay for all costs and expenses incurred by Cayman ABA, including reasonable attorney’s fees and 30% additional fee collected by the collection agency.

Fees for Legal Matters

Cayman ABA does not employ clinicians with a forensic specialty, thus activities related to legal matters are limited. Exceptions include a court order or subpoena, and in those cases, the fees are outlined below. 

• All non face-to-face work related to legal matters is billed at $500 an hour. 

• If a Cayman ABA clinician is required to appear in person, fees are $1,500 a day regardless of the length of the appearance.

Fees for Services

During the terms of this agreement Cayman ABA may provide the following billable services:

• ABA Therapy Services, which includes

  • Initial assessment

  • Direct one-on-one intervention

  • Group intervention

  • Supervision of technicians by a BCBA

  • Treatment planning, updating, and data analysis

  • Reassessment

  • Parent/caregiver training

• Clinical Services, which includes

  • Psycho-educational assessment

  • Psychological / developmental assessment

  • Psychotherapy (individual or group)

  • Counseling

  • Parent/caregiver training

• Other professional services can be requested but are not part of the service agreement may include, but not limited to: 

  • Program development 

  • Attendance to meetings or consultations with other professionals you have authorized 

  • Preparation of records or treatment summaries 

  • Time required to perform any other service which you may request

Charges are based on the amount of professional time utilized. If additional time or services (e.g., telephone calls lasting more than ten minutes, reports, treatment plans, or letters) are provided, a prorated fee will be charged. When requesting any service it is best to inquire what the charge will be.

All prices listed are in Cayman Islands Dollars. Please click here to view our current rates for ABA & Clinical Services.

CONFIDENTIALITY AND PRIVACY PRACTICES

Notice of Privacy Practices

This notice describes how medical/mental health information about you may be used or disclosed and how you can get access to this information.  Please review it carefully.

Cayman ABA has a duty to maintain privacy of your health information and to provide you with this notice.  You will be asked to sign a Release of Information Form.  Once you have signed this Confidentiality Policy and the Client Release of Information Form, Cayman ABA staff members may use or disclose your Protected Health Information (PHI) for purposes of diagnosis, treatment, obtaining payment, or to conduct healthcare operations.  For example, to receive payment for our services, Cayman ABA must provide information to the funding source being used, or to a third party collections agency if we are unable to collect debts within 2 calendar months post the original payment due date.

You are entitled to privacy in regard to the pursuit of clinical services for yourself and/or your children. This means your clinician cannot share, without your express written permission, that you are receiving services from Cayman ABA. There are, however, some exceptions to this privacy. 

There are specific and limited exceptions to this confidentiality clause. For these exceptional circumstances, disclosures may be made without your consent, authorization, or opportunity to object.  These exceptional limits to confidentiality include the following items:

1. Abuse or Neglect:  If any Cayman ABA staff member suspects abuse or neglect of a child and/or elder, he/she is mandated to make a report to the appropriate public authorities.

2. Danger:  If a Cayman ABA staff member suspects that you and/or your child are in imminent danger of harming self or someone else, he/she is mandated to make a report to the person at risk and to the public authorities. 

3. Legal Proceedings: Cayman ABA staff members may disclose PHI in response to a court order or subpoena or in certain other legal proceedings.

Additional limits to your right to confidentiality include:

1. If you are utilizing your health insurance to pay for services, the insurance company may require Cayman ABA to disclose information regarding your treatment in order to determine whether or not they will pay for services, or whether or not they will reimburse you for service.

2. Cayman ABA will utilize a collection service for unpaid balances on services rendered. All efforts will be made to resolve the issue without resorting to this; but if you are unresponsive to these efforts, then Cayman ABA will initiate collection services. If this occurs, the client understands and agrees that certain personal information will need to be disclosed to the collection agency. Cayman ABA will only disclose the minimum amount necessary to collect payment.

3. Although Cayman ABA is permitted to utilize cell phone and email communication, we need to make you aware that this communication can be intercepted, and therefore we cannot guarantee confidentiality. Please refer to Cayman ABA’s Electronic Media Policy below for more information.

I understand that all information shared with the clinicians is confidential and protected by the laws set forth under the Cayman Islands Government and the Health Practice Commission.  

During the course of the assessment and treatment, it may be necessary for my clinician(s) to communicate and collaborate with other professionals.  Written authorization will be requested for these collaborative meetings, and I understand that my clinician(s) will discuss all communications with me.  Verbal consent for limited release of information may be necessary in special circumstances.  

Privacy in Child Therapy

Clients under the age of 18 years of age who are not emancipated, and their parents, should be aware that the law may allow parents to examine their child’s treatment records. One of the major purposes of therapy is to create a safe place for child(ren) to discuss any topic in a healthy manner. Many children (and more often adolescents) will not open up and reveal information if they are aware that the information will be disclosed. Cayman ABA requests your child’s privacy be honored during the course of therapy unless he or she discloses harmful situations; at which time you would need to be involved in treatment for us to discuss how to keep your child safe. 

Experience has shown that revealing therapy notes or the content of conversations can harm the trust relationship between therapist and child(ren). No matter how carefully this is explained, the child(ren) can invariably feel betrayed and may no longer choose to be in therapy with the therapist who released the information. Sometimes this breach of trust may have an impact on other relationships as well such as the relationship between the parent(s) and the child(ren).

Client Rights

You have the following rights regarding PHI that Cayman ABA maintains about you.  To exercise any of these rights, please send an email to anoush@caymanaba.com. 

1. Right to Inspect and Copy: You have the right to inspect and request copies of information that may be used to make decisions about your care.  Usually this includes demographic and billing records, but does not include case notes.  To inspect and/or receive copies of information, you must submit a signed request in writing.  If you request a copy of information, Cayman ABA may charge a fee for the cost of copying, mailing, or other supplies associated with your request.  Cayman ABA will respond to your request within fifteen (15) days of receipt.

2. Right to Amend:  If you feel that PHI about you is incorrect or incomplete, you may ask Cayman ABA to amend the information.  You have a right to request an amendment for as long as Cayman ABA keeps the information.  Your request for amendment must be in writing and must provide a reason supporting your request.

3. Right to an Accounting of Disclosures: You have the right to request an Accounting of Disclosures regarding information that Cayman ABA staff members have made about you. You must submit your request in writing to the above email address. Your request must state a period of time for the disclosures, which may not be longer than six years and may not include dates before July 1, 2011.

4. Right to Request Restrictions on Uses and Disclosures: You may request that disclosure of confidential information be limited.  If Cayman ABA is unable to agree to that restriction, we can discuss other options, such as referral to another counselor.

5. Right to Limit Reception of Confidential Information: For example, you may request that Cayman ABA staff members only contact you at a certain telephone number or address.  You do not have to give a reason for your request.

6. Right to a Paper Copy of this Notice of Privacy Practices:  You have a right to a paper copy of this signed notice.

Other uses and disclosure of PHI and any disclosure of Case Notes will be made only with your written authorization. After such authorization is given, you may revoke that authorization at any time from future use.  This notice may be amended as needed to comply with legislative and professional requirements.

Changes to this Notice

We reserve the right to change this notice, and to make the revised or changed notice effective for medical information we already have about you, as well as any information we receive in the future. We will post a summary of the current notice in our facilities’ lobby, with its effective date, in the top right hand corner. You are entitled to a copy of the notice currently in effect. 

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Cayman Islands Health Practice Commission:

Health Practice Commission
3nd Floor, Government Administration Building, 133 Elgin Avenue
Box 132 Grand Cayman KY1-9000, CAYMAN ISLANDS
Telephone: (345) 949 -2813 / 946 -2084, Fax: (345) 946 -2845

Mandated Reporter Disclosure

All clinical and educational staff for the programs operated by Cayman ABA are mandated reporters as deemed so by Cayman Islands regulations, and/or laws.  This is also true of all social workers, teachers, and those engaged in any type of social service-oriented or clinical-oriented work; and should not restrict the work to be completed.  This is a law designed to protect children from injury, and should not be viewed as means to harm parents and caretakers.

This form shall serve as a reminder to the family of this fact, and shall also provide insight into what this disclosure means.  This disclosure shall serve as part of the client education regarding the program, and/or the client information packet.

Being deemed a mandated reporter, the Clinicians at Cayman ABA are required by law to report any and all allegations, reports, and suspicions of child abuse, neglect and maltreatment to the appropriate identified governing body.

The Multi-Agency Safeguarding Hub (MASH) unit is the governing body identified in the Cayman Islands that manages cases of child abuse, neglect, and maltreatment. All Clinicians are required by law and shall therefore report the above-mentioned incidents to the MASH unit under any circumstances where there is reasonable suspicion that a child or adult is subject to abuse or neglect.

Any report to MASH, where deemed necessary by Cayman ABA’s clinicians, shall constitute a separate case from the one managed by Cayman ABA.  For this reason, it should be noted that the Cayman ABA Clinicians shall only participate in MASH cases as required and requested by the MASH directly.  The clinical program operated by Cayman ABA shall play no part in decisions made by MASH and should be viewed as a separate organization from MASH.

The client shall sign a Mandated Reporter Disclosure Receipt Form that shall be kept in the client’s file as evidence that the above-mentioned information was provided to the client and family.

Electronic Media Policy

There are many risks to using standard unencrypted forms of electronic communication and there is no way that Cayman ABA can guarantee confidentiality of communications sent via electronic media platforms. Therefore, our policy is as follows:

The purpose of this consent is to review the option of receiving program information and any confidential protected health information (PHI) by email or text.  Please review the following and ask any questions related to these two topics before consenting with your signature below.  

1. Risk of using email/texting: The transmission of program information and/or your PHI by email and/or texting has a number of risks that you should consider prior to the use of email and/or texting.  These include, but are not limited to, the following risks: 

   1. Email and texts can be circulated, forwarded, stored electronically and on paper, and broadcast to unintended recipients. 

   2. Email and text senders can easily misaddress an email or text and send the information to an undesired recipient. 

   3. Backup copies of emails and texts may exist even after the sender and/or the recipient has deleted his or her copy.

   4. Employers and on-line services have a right to inspect emails sent through their company systems and potentially text messages sent through their company issued phone.  

   5. Emails and texts can be intercepted, altered, forwarded or used without authorization or detection. 

   6. Email and texts can be used as evidence in court.  

   7. Emails and texts may not be secure and therefore it is possible that the confidentiality of such communications may be breached by a third party.   

2. Conditions for the use of email and texts: Cayman ABA cannot guarantee but will use reasonable means to maintain security and confidentiality of email and text information sent and received. Cayman ABA are not liable for improper disclosure of confidential information that is not caused by Cayman ABA’s intentional misconduct.  Clients/parent’s/legal guardians must acknowledge and consent to the following conditions:

   1. Email and texting is not appropriate for urgent or emergency situations. Cayman ABA cannot guarantee that any particular email and/or text will be read and responded to within any particular period of time.  

   2. Email and texts should be brief/concise. The client/parent/legal guardian should call and/or schedule an appointment to discuss complex and/or sensitive situations.  

   3. All email may be printed and filed into the client’s medical record. Texts may be printed and filed as well.  This makes any information within the text or email a part of the client chart and will be discoverable upon audit, record request, subpoena, and/or court order. 

   4. Cayman ABA will not forward client’s/parent’s/legal guardian’s identifiable emails and/or texts outside of Cayman ABA without the client’s/parent’s/legal guardian’s written consent, except as authorized by law.  

   5. Clients/parents/legal guardians should not use email or texts for communication of sensitive medical information.  

   6. Cayman ABA is not liable for breaches of confidentiality caused by the client or any third party. 

   7. It is the client’s/parent’s/legal guardian’s responsibility to follow up and/or schedule an appointment if warranted.   

Electronic Media Policy Client Acknowledgement and Agreement:

1. I understand that emailing communication will be used for the purpose of simplifying and expediting scheduling/ administrative matters only.

2. I understand that email communication is not to be used to provide/receive treatment services or take the place of treatment sessions.

3. I understand that clinicians will not utilize text messaging or text messaging applications as a valid option of communication, except in the instance of urgent scheduling concerns.

4. I understand that clinicians will never communicate via public media or social media (e.g., Facebook, Instagram, Twitter, Snapshot, LinkedIN or any other platform) under any circumstance.  In addition, clinicians will not add clients or engage with clients on the personal and/or professional media profile that is assigned to a clinician or a client.

5. I acknowledge that in a life-threatening emergency, clients should call 911 or proceed to the nearest hospital emergency room.

6. I have been advised and understand that the use of email and other forms of technology has not been defined as a best-practice strategy.  Any information exchanged electronically or with the use of technology increases the risk of confidentiality breaches. No technology is 100% secure and the clinician cannot guarantee protection from unauthorized attempts to access, use, or disclose personal information exchanged electronically.

7. I have thoroughly considered all of the above information, and I have obtained whatever additional input and/or professional advice I deem necessary in making an informed decision regarding electronic communication.

8. By signing, I consent to the use of emailing as needed for scheduling and administrative purposes, as well as “WhatsApp” for communications among team members, within the guidelines above. If more urgent help is needed, I will utilize the crisis services listed above. Furthermore, if at any time my clinician or I believe emailing is interfering in my treatment process or being used ineffectively, either of us can revoke this consent verbally, refuse to respond to emails, and insist upon a verbal conversation before proceeding. 

9. I acknowledge that I have read and fully understand this consent form.  I understand the risks associated with the communication of email and/or texts between Cayman ABA and me, and consent to the conditions and instructions outlined above, as well as any other instructions that Cayman ABA may impose to communicate with client by email or text; (any specific instructions will be documented within the progress notes of the client’s chart).  Based on my understanding of the risks, I consent to the following Email communications and WhatsApp communications.

This consent will remain active until the time of discharge from program services or at the time the consent is revoked (whichever is earlier).