The following is for clients of Charles E. Cote, LCSW, Chris Rawls, MHC-LP and Kristen Julian, LMSW:

Charles E. Coté, LCSW holds a Master's Degree in Social Work from Syracuse University. His coursework and practice focus emphasized work with children and adolescents, individual adults, couples, and families. He has intensive training in Dialectical Behavioral Therapy (DBT), Family Systems Theory and Acceptance and Commitment Therapy (ACT). He has extensive experience working in the field, over 30 years. He is licensed as a clinical social worker (LCSW) with the New York State Licensing Board and abides by its Code of Ethics. He participates in an ongoing consultation group comprised of clinical social workers and psychologists. He is a member of the National Association of Clinical Social Workers, The Association of Contextual and Behavioral Science, and the Society for Descriptive Psychology. He is certified in strategic non-profit leadership and serves on the boards of 13thirty Cancer Connect and the Society for Descriptive Psychology.

Chri Rawls, MHC-LP holds a Master's Degree in Mental Health Counseling from Brockport State University. Chris practices under Charles E. Coté's direct supervision. His approach to mental health counseling is compassionate, evidence-based, and professional. He believes healing is best achieved through forming genuine, therapeutic relationships in a supportive and judgement free environment. I believe that by focusing on goals which clients are personally invested in, major positive changes in their life can occur. Whether you need new perspectives on life events, support healing from trauma, or help developing more effective coping strategies, strategies supported by research. He has clinical experience with individuals who struggle with symptoms of depression, anxiety, mood disorders, relationship issues, trauma, LGBTQIA+ competent care.

Kristen Julian, LMSW She holds certifications as a Yoga Teacher, as well as in CPR, First Aid, NARCAN, and Mental Health First Aid.

Her therapeutic approach draws from evidence-based techniques such as motivational interviewing, solutions-focused therapy, cognitive behavioral therapy, acceptance and commitment therapy, and functional family therapy. By incorporating these approaches, she tailors sessions to meet client's specific needs and goals. Kristen practices under Charles E. Coté's direct supervision.

Rebecca Barrett, LMSW specializes in working with children and young adults (ages 3 to 21) experiencing depression, anxiety, low self-esteem, chronic illness or pain, life transitions, self-harm, and disruptive behavior. She helps people to navigate the unique challenges that they might be facing, with the goal to provide a safe space for young minds to express themselves, develop coping skills, and build resilience.  By utilizing creative and expressive techniques, including play therapy, Acceptance and Commitment therapy (ACT), Cognitive-Behavioral therapy (CBT), Dialectical Behavioral therapy (DBT), Internal Family Systems (IFS), Schema therapy, and experiential dynamic psychotherapies, she is able to work collaboratively to tailor her approach to meet the unique needs of each individual client and enhance their overall emotional and behavioral well-being. 

Nathan Hendrickson, MHC-LP is committed to supporting individuals on their journey toward healing and personal growth. Nathan provides empathetic and evidence-based counseling services to help clients navigate through various challenges. Nathan has worked in higher education for the past 16 years and has worked with many people of various ages and stages of life. Nathan's focus of research is working with injured and recovering athletes.

Approach: Nathan's therapeutic approach is grounded in empathy, collaboration, and evidence-based practices. He believes in creating a safe and nonjudgmental space where clients can explore their thoughts, feelings, and experiences freely. By integrating modalities such as Client-Centered Therapy, Cognitive Behavioral Therapy (CBT), mindfulness techniques, and solution-focused therapy, Nathan tailors his approach to meet each individual's unique needs and goals. Nathan practices under Charles E. Coté's direct supervision.

Joanne Quevedo, LMSW specializes in group and individual therapy for victims of domestic violence covering everything from safety planning to trauma informed care and interpersonal therapy. Joanne practices under Charles E. Coté's direct supervision.

Confidentiality

All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your (client's) written permission, except where disclosure is required by law.  Most of the provisions explaining when the law requires disclosure were described to you in the notice of privacy practices that you received with this form.

When disclosure is required by law

Some of the circumstances where disclosure is required by the law include: where there is a reasonable suspicion of child, dependent, or elder abuse or neglect; and where a client presents a danger to self, to others, to property, or is gravely disabled (for more details see also notice of privacy practices form).

When disclosure may be required

Disclosure may be required pursuant to a legal proceeding.  If you place your mental status at issue in litigation initiated by you, the defendant may have the right to obtain the psychotherapy records and/or testimony by insert name of psychotherapist. In couple and family therapy, or when different family members are seen individually, confidentiality and privilege do not apply between the couple or among family members. I will use clinical judgment when revealing such information. I will not release records to any outside party unless so authorized to do so by all adult family members who were part of the treatment.

Emergencies

If there is an emergency during our work together, or in the future after termination, where I become concerned about your personal safety, the possibility of you injuring someone else, or about you receiving proper psychiatric care, I will do whatever s/he can within the limits of the law to prevent you from injuring yourself or others and to ensure that you receive the proper medical care.  For this purpose, I may also contact the police, hospital, or the person whose name you have provided on the biographical sheet.

Health Insurance and Confidentiality of Records

Disclosure of confidential information may be required by your health insurance carrier or HMO/PPO/MCO/EAP in order to process the claims. If you so instruct me only the minimum necessary information will be communicated to the carrier. Unless authorized by you explicitly, the psychotherapy notes will not be disclosed to your insurance carrier. I have no control or knowledge over what insurance companies do with the information submitted or who has access to this information. You must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk to confidentiality, privacy, or to future eligibility to obtain health or life insurance. The risk stems from the fact that mental health information is entered into insurance companies' computers and soon will also be reported to the Congress-approved National Medical Data Bank. Accessibility to companies' computers or to the National Medical Data Bank database is always in question, as computers are inherently vulnerable to break-ins and unauthorized access.  Medical data have been reported to have been sold, stolen, or accessed by enforcement agencies; therefore, you could be in a vulnerable position.

Confidentiality of e-mail, cell phone, and fax communication

It is very important to be aware that e-mail and cell phone (also cordless phones) communication can be relatively easily accessed by unauthorized people and, hence, the privacy and confidentiality of such communication can be easily compromised.  E-mails, in particular, are vulnerable to such unauthorized access due to the fact that servers have unlimited and direct access to all e-mails that go through them.  Faxes can be sent erroneously to the wrong address.  Please notify me at the beginning of treatment if you decide to avoid or limit in any way the use of any or all of the above-mentioned communication devices.  Please be advised that I exclusively use a cellular telephone to communicate with you and that requesting the exclusive use of a land line will hamper my ability to communicate with you quickly. Please do not use e-mail or faxes in emergency situations.

Litigation Limitation

Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters that may be of a confidential nature, it is agreed that should there be legal proceedings (such as, but not limited to, divorce and custody disputes, injuries, lawsuits, etc.), neither you (client) nor your attorney, nor anyone else acting on your behalf will call on me to testify in court or at any other proceeding, nor will a disclosure of the psychotherapy records be requested.

Consultation

I consult regularly with other professionals regarding my clients; however, the client's name or other identifying information is never mentioned.  The client's identity remains completely anonymous, and confidentiality is fully maintained. Such consultation is solely for the purpose of quality improvement.

Considering all of the above exclusions, if it is still appropriate, upon your request, I will release information to any agency/person you specify unless I conclude that releasing such information might be harmful in any way.

Telephone and emergency procedures

If you need to contact me between sessions, please leave a message for me at (585) 383-8338 and your call will be returned as soon as possible. I check messages a few times a day but never during the nighttime, unless out of town.  I check messages less frequently on weekends and holidays.  If an emergency situation arises, please indicate it clearly in your message.  In an emergency, If you need to talk to someone right away, you can call my emergency number (585) 406-7264 or if I'm not available, 911.

Payments and insurance reimbursement

Clients of Charles E. Coté, LCSWare expected to pay the standard fee of $150 per 55-minute individual session, $250 for couples at the end of each session, $150 for the initial intake session unless covered by medical insurance (he takes Excellus, MVP, United Health Care and Aetna, he is currently out of network with Cigna) and $250 per session for couples/families.  Clients of Kristen Julian, LMSW, Chris Rawls, MHC-LP, Rebecca Barrett, LMSW, Nathan Hendrickson, MHC-LP and Joanne Quevedo, LMSW are expected to pay $120  per 55-minute session (there is a sliding scale available depending on household income with the lowest rate being $95), $200 for couples (with a sliding scale available to the lowest rate of $100). Kristen Julian, Rebecca Barrett and Joanne Quevedo accept Excellus and Aetna. They are out of network for all other carriers. Chrissy Rawls and Nathan Hendrickson are not able to accept any insurance at this time. Telephone conversations, site visits, report writing and reading, consultation with other professionals, release of information, reading records, longer sessions, travel time, and so forth, will be charged at the same rate, unless indicated and agreed otherwise.  Please notify me if any problem arises during the course of therapy regarding your ability to make timely payments. Clients who are able to use insurance will be billed the appropriate co-payment and I will submit a bill to the insurance company for the balance of the fee. As was indicated in the section "Health Insurance and Confidentiality of Records," you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues/conditions/problems that are the focus of psychotherapy are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage.

Mediation and arbitration

All disputes arising out of or in relation to this agreement to provide psychotherapy services shall first be referred to mediation before, and as a precondition of, the initiation of arbitration.  The mediator shall be a neutral third party chosen by agreement of myself and client(s).  The cost of such mediation, if any, shall be split equally, unless otherwise agreed.  In the event that mediation is unsuccessful, any unresolved controversy related to this agreement should be submitted to and settled by binding arbitration in Monroe County, New York in accordance with the rules of the American Arbitration Association, that are in effect at the time the demand for arbitration is filed. Notwithstanding the foregoing, in the event that your account is overdue (unpaid) and there is no agreement on a payment plan, I can use legal means (court, collection agency, etc.) to obtain payment. The prevailing party in arbitration or collection proceedings shall be entitled to recover a reasonable sum for attorneys' fees. In the case of arbitration, the arbitrator will determine that sum.

The process of therapy/evaluation

Participation in therapy can result in a number of benefits to you, including improving interpersonal relationships and resolution of the specific concerns that led you to seek therapy. Working toward these benefits, however, requires effort on your part. Psychotherapy requires your very active involvement, honesty, and openness in order to change your thoughts, feelings, and/or behavior. I will ask for your feedback and views on your therapy, its progress, and other aspects of the therapy and will expect you to respond openly and honestly. Sometimes more than one approach can be helpful in dealing with a certain situation. During evaluation or therapy, remembering or talking about unpleasant events, feelings, or thoughts can result in your experiencing considerable discomfort or strong feelings of anger, sadness, worry, fear, and so forth, or experiencing anxiety, depression, insomnia, and so forth. I may challenge some of your assumptions or perceptions or propose different ways of looking at, thinking about, or handling situations that can cause you to feel very upset, angry, depressed, challenged, or disappointed. Attempting to resolve issues that brought you to therapy in the first place, such as personal or interpersonal relationships, may result in changes that were not originally intended. Psychotherapy may result in decisions about changing behaviors, employment, substance use, schooling, housing, or relationships. Sometimes a decision that is positive for one family member is viewed quite negatively by another family member. Change will sometimes be easy and swift, but more often it will be slow and even frustrating. There is no guarantee that psychotherapy will yield positive or intended results. During the course of therapy, I am likely to draw on various psychological approaches according, in part, to the problem that is being treated and my assessment of what will best benefit you. These approaches include behavioral, cognitive-behavioral, psychodynamic, family therapy, existential, and/or psycho-educational interventions.

Discussion of treatment plan

Within a reasonable period of time after the initiation of treatment, I will discuss with you (client) my working understanding of the problem, treatment plan, therapeutic objectives, and view of the possible outcomes of treatment.  If you have any unanswered questions about any of the procedures used in the course of your therapy, their possible risks, my expertise in employing them, or about the treatment plan, please ask and you will be answered fully.  You also have the right to ask about other treatments for your condition and their risks and benefits. If you could benefit from any treatment that I do not provide, I have an ethical obligation to assist you in obtaining those treatments.

Termination

As set forth above, after the first couple of meetings, I will assess if I can be of benefit to you.  I do not accept clients who, in my opinion, I cannot help.  In such a case, I will give you a number of referrals that you can contact.  If at any point during psychotherapy, I assess that I am not effective in helping you reach the therapeutic goals, I am obliged to discuss it with you and, if appropriate, to terminate treatment.  In such a case, I would give you a number of referrals that may be of help to you. If you request it and authorize it in writing, I will talk to the psychotherapist of your choice in order to help with the transition. If at any time you want another professional's opinion or wish to consult with another therapist, I will assist you in finding someone qualified, and, if I have your written consent, I will provide her or him with the essential information needed. You have the right to terminate therapy at any time. If you choose to do so, I will offer to provide you with names of other qualified professionals whose services you might prefer.

Dual relationships

Not all dual relationships are unethical or avoidable. Therapy never involves sexual or any other dual relationship that impairs objectivity, clinical judgment, or therapeutic effectiveness or can be exploitative in nature. I will assess carefully before entering into nonsexual and nonexploitative dual relationships with clients. Rochester can at times feel like a small town and some clients know each other or me from the community. Consequently, you may bump into someone you know in the waiting room or into me out in the community. I will never acknowledge working therapeutically with anyone without his/her written permission.  Many clients choose their therapist because they know him/her before they enter into therapy with him/her and/or are aware of his/her stance on the topic.  Nevertheless, I will discuss with you, if pertinent, the often-existing complexities, potential benefits, and difficulties that may be involved in such relationships.  Dual or multiple relationships can enhance therapeutic effectiveness but can also detract from it and often it is impossible to know that ahead of time.  It is your, the client's, responsibility to communicate if a dual relationship becomes uncomfortable for you in any way. I will always listen carefully and respond accordingly to your feedback.  I will discontinue the dual relationship if I find it interfering with the effectiveness of the therapeutic process or the welfare of the client and, of course, you can do the same at any time.

Cancellation

Since scheduling of an appointment involves the reservation of time specifically for you, a minimum of 24 hours notice is required for rescheduling or canceling an appointment. Unless we reach a different agreement, the full fee will be charged for sessions missed without such notification.  Most insurance companies do not reimburse for missed sessions, so you would be responsible for the full fee for that session, not just your copayment, if you are using your insurance.

Path Forward Counseling is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information.  If you have questions about any part of this notice or if you want more information about the privacy practices at the Psychotherapy Practice of Charles E. Coté, LCSW please contact:

Path Forward Counseling

2480 Browncroft Blvd, Suite 256

Rochester, NY 14625

(585) 383-8338

Effective Date of This Notice:  April 14, 2003

I.              How Path Forward Counseling may Use or Disclose Your Health Information

The Path Forward Counseling collects health information from you and stores it in a chart and on a computer.  This is your medical record.  The medical record is the property of Path Forward Counseling, but the information in the medical record belongs to you.  Path Forward Counseling protects the privacy of your health information.  The law permits Path Forward Counseling to use or disclose your health information for the following purposes:

1.             Treatment.              The following type of information is typically exchanged with your Primary Care Physician, Referring Health Care Referral Professionals, Managed Care Quality Auditors, Clinical Supervisors and Health Care Providers involved in your direct care in order to ensure the highest quality and coordination of treatment and does not require written authorization: Identifying Data (e.g., Name, ID#, Address, Age, Sex), A summary of the Presenting Problem, A brief History & Background, Clinical Assessment, A Progress Summary, Treatment & Recommendations, Known Medical Conditions relevant to patient care & treatment, Diagnosis (e.g. DSM IV classification), Known Allergies & Medications.

2.             Payment.                The following type of information is typically exchanged with 3rd Party Payers in order to process claims and does not require written authorization: Identifying Data (e.g., Name, ID#, Address, Date of Birth, Sex, Relationship to Insured, Patient Status, Insurance Plan), DSM-IV Diagnosis (if required), CPT Procedural Codes, Place of Service & Type of Service, Prior Authorization Number, Patient's Condition Relative to Employment, Auto Accident, or Other Accident, Patient's Referring Physician, Date(s) of Service, Charges for Service, Benefit eligibility, Payment Remittances, advices and explanation of benefits, Accounting & Billing Ledgers/Statements. Disclosures generated by your therapist are transmitted by mail to the specific 3rd Party Payer (e.g., Excellus, Preferred Care, etc) using the Rochester Community Health Care Claim Form according to the 3rd Party Payer's procedures with a copy retained in your chart. Information is obtained from 3rd Party Payers via Telephone, Fax, World Wide Web, and by Mail and procedures are in place to protect this information (e.g., password protection, provider id required, locked filing cabinets, locked office).  For 3rd Party Payers who do not require the use of the Rochester Community Health Care Form, this information will be typically disclosed using a standard Invoice, Statement or Receipt form either to you directly or to the 3rd Party Payer with your verbal approval and direction. 

3.             Regular Health Care Operations.        We keep an appointment book that lists your name and appointment time.  This book is accessible only to your therapist.  Any verbal, written or electronic exchange of information (e.g., e-mail) between you and your therapist is kept in a password protected computer, medical chart kept in a locked filing cabinet, password protected voice mail system or confidential message pad that is accessible only to your therapist.  Written authorizations to use, disclose or request protected health care information is transmitted by mail or fax to only the individuals you authorize with a copy kept in your confidential medical record.

4.             Information provided to you.               Any information we provide to you will be delivered during an actual session, by mail addressed specifically to you, or by e-mail to an address you provide and protect.  These disclosures will be kept and protected in your medical record or designated file.  In the event that we call you at a phone number you provide, every effort will be made to protect your health care information.  For example, we will not reveal sensitive data about your treatment to anyone other than you in person (i.e., we will not leave detailed voice mail messages other than a number for you to call, we will not leave a detailed message with anyone other than you or your designated representative).

5.             Notification and communication with family.     We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death.  If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification.  If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.

6.             Required by law.    As required by law, we may use and disclose your health information.

7.             Public health.         As required by law, we may disclose your health information to public health authorities for purposes related to:  preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.

8.             Health oversight activities.   We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.

9.             Judicial and administrative proceedings.          We may disclose your health information in the course of any administrative or judicial proceeding.

10.           Law enforcement.  We may disclose your health information to a law enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.

11.           Deceased person information.            We may disclose your health information to coroners, medical examiners and funeral directors.

12.           Public safety.          We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.

13.           Worker's compensation.      We may disclose your health information as necessary to comply with worker's compensation laws.

14.           Change of Ownership.         In the event that Path Forward Counseling is sold or merged with another organization, your health information/record will become the property of the new owner.

II.             When Path Forward Counseling May Not Use or Disclose Your Health Information

Except as described in this Notice of Privacy Practices, Path Forward Counseling will not use or disclose your health information without your written authorization.  If you do authorize Path Forward Counseling to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.

III.            Your Health Information Rights

1.             You have the right to request restrictions on certain uses and disclosures of your health information.  Path Forward Counseling is not required to agree to the restriction that you requested.

2.             You have the right to receive your health information through a reasonable alternative means or at an alternative location.  Your request must be made in writing identifying the specific information you want to access, and how you want to access the information (i.e., inspection, copies, or alternate forms like e-mail or verbal).  Depending on the scope of your request, you may be charged for reasonable clerical cost in making the records available for inspection at a rate of $5 per quarter hour and you may be required to pay these costs before inspecting the records.  You may also be charged up to $.75 per page for copies though you cannot be denied access due to inability to pay.  This organization will also charge the value of postage used (if any) and $80 per hour in consulting fees for preparations of summaries of protected health information, if a summary is requested.

3.             You have the right to inspect and copy your health information with the exception of psychotherapy process notes (i.e., notes taken during the course of a therapy session).

4.             You have a right to request that Path Forward Counseling amend your health information that is incorrect or incomplete.  Path Forward Counseling is not required to change your health information and will provide you with information about our denial and how you can disagree with the denial.

5.             You have a right to receive an accounting of disclosures of your health information made by Path Forward Counseling, except that Path Forward Counseling does not have to account for the disclosures described in parts 1 (treatment), 2 (payment), 3 (health care operations), and 4 (information provided to you), of section I of this Notice of Privacy Practices.

6.             You have a right to a paper copy of this Notice of Privacy Practices.

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact

Charles E. Coté, LCSW, (585) 383-8338.

IV.            Changes to this Notice of Privacy Practices

Path Forward Counseling reserves the right to amend this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it maintains, including information that was created or received prior to the date of such amendment.  Until such amendment is made, Path Forward Counseling is required by law to comply with this Notice. 

Revised Notice will be communicated at the next scheduled appointment after the revision date.

V.             Complaints

Complaints about this Notice of Privacy Practices or how Path Forward Counseling handles your health information should be directed to:

Charles E. Coté, (585) 383-8338

If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:

Department of Health and Human Services

Office of Civil Rights

Hubert H. Humphrey Bldg.

200 Independence Avenue, S.W.

Room 509F HHH Building

Washington, DC  20201

You may also address your compliant to one of the regional Offices for Civil Rights.  A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.

I require 24 hour notice to cancel an appointment. If a client does not call at least 24 hours in advance to cancel or doesn't show for an appointment, the client accepts responsibility to pay the full amount for the missed session. If a client doesn't attend sessions consistently, or fails to make timely payments, treatment may be suspended or terminated. I will discuss this issue with a client in advance of taking such action in hopes of resolving the problem and continuing treatment.

Your therapist can be called or texted until 8 pm for non-emergencies, and calls will be returned within the next 24 hours. Emergency calls are accepted 24 hours a day, 7 days a week on my cell phone (585) 406-7264. If I have a scheduled time away from the office, I will inform my clients in advance and leave the number of an on-call therapist on my voice mail.

Numbers to call in the case of a medical or mental health emergency:

LIFELINE: (585) 275-5151 or 1 (800) 310-1160

Emergency: 911

A client can also go to the nearest Emergency Department.

Clients agree to contact one or more of these resources in the case of an emergency.