Office Policies and Information About My Practice

Welcome to my practice.  I appreciate the opportunity to be of help to you or your family.

This information provides answers to many questions that clients often ask about therapy. Please let me know if you have any further questions.

This handout talks about the following:

1)    How do I conduct psychotherapy?

2)    Appointments, cancellations, and no-shows.

3)    How can I be reached outside of session? Risks of email and text messages.

4)    IMPORTANT NOTE REGARDING EMERGENCIES.

5)    How long does therapy take?

6)    What are the risks and benefits of psychotherapy?

7)    My fees, whether I take insurance, and how payments are handled.

8)    Additional issues regarding privacy

9)    Notice of Sole Proprietorship in Independent Practice.

10) What is a “PsyD” and what training do I have?

1. How do I conduct therapy?

There are many types of therapy, and the type that is helpful for you depends on what issues you would like to work on.  Some types of therapy have been shown to work well for certain types of problems, and those are called “empirically validated treatments.”  I feel it is important to use these types of treatments whenever possible (especially when conducting Diagnostic Assessments or Psychological Evaluations, for which I only use empirically validated measures).  However, when it comes to psychotherapy, every client is different, and sometimes empirically validated treatments don’t work as well as we would hope.  There is also a lot about therapy that we still don’t fully understand (and not every therapeutic approach has been rigorously tested, or “empirically validated”).  So, we’re often not really certain what “works,” and what doesn’t.  So, while I do use empirically validated treatments, I also use other types of therapy that have been commonly accepted by the mental health profession as being helpful.  In short, I use interventions that I think will work the best for your particular concerns.  This approach is called “eclectic,” which means “mixed.” 

I also follow the American Psychological Association’s guidelines on ethics and professional behavior, and I follow the rules and regulations for Psychologists put forth by the State of California (who is responsible for regulating my License to Practice Psychology).  Therefore, I do not use “experimental” types of therapy.  I also do not work with clients I do not think that I can help or use treatments that I am not adequately trained to provide.  Some of the types of work that I do not do:  child custody evaluations, drug or alcohol treatment, worker’s compensation evaluations, forensic evaluations, or primary treatment for eating disorders (although I will work with clients who are under the care of a physician or other eating disorders treatment program).  I will only accept you as a client if I feel optimistic about our ability to make progress.

I feel that you will gain the most from therapy if you feel comfortable in your choice of therapist and type of therapy that we are using. A therapeutic relationship is just like any other healthy relationship, meaning that it is based on communication and honesty.  If at any time you feel uncomfortable, or if you don’t understand what we are doing, please ask and I will be happy to answer questions.  There may be times when I cannot answer all of your questions as it would be counterproductive to your progress to do so, but I will tell you when this is the case.

During our first session, we will discuss your goals for therapy.  By the end of our first or second session, we will discuss an action plan, or the best way to reach those goals.  That action plan may include a Psychological Evaluation, which is a more in-depth evaluation of your concerns, or a Diagnostic Assessment, which is formal testing.  We will discuss how long I think your treatment or testing should take, costs, and the risks and benefits of treatment.  We will re-assess progress at every visit.  I may take notes during our sessions.  You may take notes as well if you like.

2. Appointments, Cancellations, and No-Shows:

When I make an appointment with you, I reserve that time especially for you (I do not “double book,” for example). 

You must notify me by phone 24 hours in advance if you need to cancel, otherwise you will be charged the full amount of your appointment fee, unless we both agree that the cancellation was unavoidable.  I will extend the same courtesy to you. If you “no-show,” and do not call to cancel the appointment, you will be charged the full amount of your appointment fee.

This means that if you experience a personal or family emergency, or you wake up the day of your appointment and find that you or your child is too sick to attend our session, call me and we will find another time for our session.  I will notify you as well if I am unable to attend the session.  If I find that this policy is being abused and you have frequent cancellations without 24-hour notice, then you will be charged for the missed appointment. 

3. How can I be reached by outside of sessions? Risks of email and text messages.

You may need to call, email, or text me in order to change appointment times (and there is no charge for this).  Please be aware that email and text messaging is not secure, and that by using email or text communication you assume any risks of disclosure of personal information that may be contained therein.  I recommend using the phone whenever possible, and you are able to call me at any time. I usually do not answer the phone when I am with another client, but you are always able to leave me a message. Generally, I will return messages within 24 hours to 48 hours, except for Sundays and holidays.

4. Important note regarding emergencies:  I do not have after-hours or emergency services.  If you are experiencing a sudden or severe worsening of symptoms, or if you are feeling that you are a danger to yourself or others, you must call 911 or go to the nearest emergency room. 

Once you are in a safe location, such as the hospital, leave me a message if you can, with the best way to contact you so that I can follow up with you as soon as is feasible. If we find that my services are not sufficient to keep you or others safe, we will discuss additional services, which might include more intensive therapy, medication management with a psychiatrist or other medical doctor, therapeutic group services, or inpatient mental health treatment.

5. How long does psychotherapy take?

Most of my clients see me once per week for a 50-minute session for 3 to 4 months.  After that some clients may benefit from continuing to see me for a few more months, although less often, maybe once every two weeks.  Some clients feel it helpful to continue to see me for a longer period of time.  Then therapy ends, called “termination,” and that can be a very important and valuable part of our work together.  Either of us can decide that it is time to terminate therapy if we feel it is in your best interest.  If you wish to stop therapy at any time, I ask that you agree now to meet for one last session to review our work together, answer any questions you may have, and to discuss any future work or referrals that might be helpful to you.  If you would like to take a “time out” from therapy, we can discuss that too, so that the “time out” can be more helpful. 

6. The risks and benefits of psychotherapy:

By engaging in psychotherapy, you may experience relief right away and begin to feel better.  Hundreds of well-designed research studies have shown that psychotherapy can be helpful for a wide range of symptoms and disorders, including depression, anxiety, grief, sleep problems, relationship problems, behavior issues in children, and stress, among other issues.  You may feel more energized about your work and life goals.  Your family life or friendships may become more satisfying.  You may clarify your values and feel more comfortable in your identity.  You may feel generally happier and more peaceful.  By reducing stress, you may sleep better and take better care of yourself, which may improve your physical health.

However, it is important to understand the risks of psychotherapy as well.  The benefits noted above may not happen immediately, and it may take time to feel better.  In order to make the changes necessary in your life or in your pattern of coping, you may experience a temporary worsening of symptoms.  By talking about the issues that are bothering you, it may bring up uncomfortable feelings.  You may experience sadness, guilt, anger, hopelessness, frustration, anxiety, or other negative emotions.  You may recall unpleasant memories.  These feelings and memories may bother you at work, school, or affect your sleep.  Your family relationships might be disrupted, possibly leading to estrangement or divorce, or family “secrets” might be discovered.  Friends, family or co-workers may not like the “changes” they see in you as a result of therapy, or may even mistakenly see you as “weak” for seeing a therapist.  This may heighten your distress.  Many of these risks are to be expected when people are making important changes in their lives, and we can discuss how to reduce significant or serious symptoms while you are making progress.  Finally, despite our best efforts, there is a risk that therapy will not be helpful for you.  If I believe that this is the case, I will discuss it with you and make appropriate referrals to other professionals who may be of help.

7. My fees, whether I take insurance, and how payments are handled:

At this time, I do not take health insurance.  I believe that this allows me to provide you with more privacy than if insurance were used.  If I were to bill your insurance, I would be required to disclose your personal health information, including diagnosis, to your insurance company.  This may result in denial of future health insurance or life insurance (see my Notice of Privacy Practices for full information on how your health information can be used).  Insurance companies also may set limits on the number or type of sessions that are authorized. 

If you would like to use your insurance benefits, I can provide you with a “super bill” that includes the information needed for your insurance company to process the claim.  Your insurance company may reimburse you for part of my fee if your insurance policy includes “out of network benefits.”  Contact your insurance company to ask whether my services would be partially reimbursed, and what they would require from me in order to process your claim.  By engaging in therapy with me, you agree to pay the fee discussed at the time of service, whether or not your insurance company later reimburses you for all or part of the fee. If the recipient of services or legal guardian of the recipient of services does not pay for services as agreed, your basic personal information, such as name, address, and outstanding balance due, may be released to a collections agency to facilitate the collection of fees. You will be notified prior to the release of your information to provide you with the opportunity to make prompt payment.

      Payment is due at the time of service. 

·      You will be given a receipt for services rendered at the end of each visit.

·      I accept checks, debit cards, and credit cards (Visa, MasterCard, Discover, American Express).

·      All returned checks incur a $20 service fee.

      My fees are as follows:

·      Initial evaluation (code: 90801) for 50 minutes is $150.00

·      Clinical session for 50 minutes for individuals (code: 90806) is $125.00

·      Clinical session for 50 minutes for family therapy (code: 90846 or 90847) is $150.00

·      Group therapy is $35 per family

·      Diagnostic Assessments are varied in length and complexity, so fees will vary

·      Expert Witness fee, including related document preparation time, is $175 per hour

·      There is no charge or obligation for the initial, brief (15-20) minute consultation by phone or in person to determine if my services can be of help

·      There is no charge for brief (5-10) minute calls or emails to change appointments.

·      All other phone calls will be charged at my clinical rate of $125 per session.  This includes phone conferences with other professionals regarding your care.

·      Other services: Visits to schools, hospitals, or your home will be charged at the regular session rate.

8. Additional issues regarding privacy:

This is a small county, and a small community, so it is quite possible that we will run in to each other outside of the therapy setting, such as the grocery store.  To protect your privacy, I will not acknowledge you or make contact with you, unless you initiate it.  It will be your decision whether to talk with me or not, and whether or not you introduce me to whomever might be with you at the time.

You may be referred to me by other mental health care providers or medical providers in the community with whom I work.  With your consent, I may share information about your condition and progress with your mental health care provider or medical provider in order to coordinate treatment.  Only necessary information is shared in order to provide you with proper diagnosis and treatment.  Your privacy is protected under Health Insurance Portability and Accountability Act of 1996 (HIPAA).  See my Notice of Privacy Practices for more information.

At times I may consult with other, neutral “third party” professionals regarding your care, such as psychologists, physicians or other specialists who are not part of your treatment team.  Consultation is an important and recommended part of

8. Notice of Sole Proprietorship in Independent Practice:

I am a sole proprietor in independent practice.  This means that even though I share a waiting room and office space with other mental health providers, I do not practice as part of a group.  I maintain my own records and billing, I use my own forms and letterhead, and I practice only under my name, Laurie Ferguson, PsyD.  I do not share any of your personal information with the other mental health providers with whom I share office space, unless they are part of your treatment team and you have given me permission to do so.

9. What is a “PsyD” and what training do I have?

I am a Psychologist, which is a mental health provider who has received a Doctorate degree in Psychology, which is what my degree “PsyD” means.  (Other Psychologists have “PhD” after their name, which means they have a Doctorate in Philosophy of Psychology.)  In the state of California, you must be licensed in order to clinically treat patients as a Psychologist. My California Psychologist License is PSY20842.

·      I began working in the mental health field in 1996, and I am trained and experienced in helping children, adults and families. 

·      In 2002 I obtained my Doctorate in Clinical Psychology from The Wright Institute in Berkeley, which is accredited by the American Psychological Association.  My training specifically involved clinical treatment, psychological evaluations, and diagnostic assessment.  While my training included working with clients of diverse ages and backgrounds, I also trained specifically to treat and assess children. 

·      I trained at The Children’s Hospital in Denver, Colorado, which is accredited by the American Psychological Association to provide training to Doctoral candidates. I completed rotations in neuropsychology, Consultation & Liaison services, in-patient child and adolescent services, emergency evaluations, out-patient child and family psychotherapy, and psychological assessment.  Following my training, I continued to provide psychological assessments and therapy for the Child Development Unit, which specializes in pervasive developmental disorders and other childhood mental health issues.

·      I completed a post-doctoral residency at The National Jewish Medical and Research Center in Denver, which specializes in treating children with asthma, allergies, and other immunological diseases. 

·      I have also worked in other in-patient and out-patient settings, including the San Francisco Department of Public Health, the San Francisco County Jail, and the University of San Francisco Child and Family clinic. 

·      I am a member of the American Psychological Association (APA) and the California Psychological Association (CPA).  I am also a member of Central Coast Psychological Association, where I am Co-Chair of the Ethics Committee for 2010-2011.

Again, thank you for the opportunity to be of help to you or your family.

Please let me know if you have any questions at any time during your treatment.

Good Night, Sleep Tight Better Sleep Tonight

About 75% of my patients complain of poor sleep. Most have tried everything, but still can't fall asleep, wake up in the middle of the night, or have bad dreams. Sometimes sleep is interrupted by a bathroom trip, snoring, or a noisy environment. Many of us feel tired the next day, even if we do manage to sleep through the night.

Poor sleep can look like many different things. Some people are even wrongly diagnosed, when actually they are just plain tired. Do you or your child seem to have:

-- learning problems
-- poor attention
-- hyperactivity
-- memory problems
-- no motivation
-- mood swings
-- irritability or anger
-- "meltdowns" or tantrums
-- depression
-- worry
-- poor coping skills
-- behavior problems or oppositionality
-- problems with drugs or alcohol
-- schizophrenic symptoms

Yes, you read that correctly. Even schizophrenic symptoms, such as hallucinations and delusions, can occur if we are severely sleep deprived. That doesn't mean you have schizophrenia (or other mental health issues) necessarily. Sleep problems make our bodies and mind act in ways that wouldn't happen if we were able to regularly get a solid night's sleep.  It's no wonder that sleep deprivation has been used to extract information from prisoners of war.

What if you do have, say, Attention Deficit-Hyperactivity Disorder (ADHD), learning difficulties, autism, or even schizophrenia?  Sleep problems can make any mental (or physical) health issue worse. In fact, improving sleep can be the single most important thing we do for ourselves.  Good sleep not only improves mental health, it also has a positive impact on heart health, obesity, diabetes, safety when driving, job performance, and even personal relationships.

SLEEP BETTER TONIGHT!
Here are some easy tips to have a better night's sleep tonight. It's very important to try these ideas consistently for at least two weeks. Remember, don't give up if you don't see improvement right away. It can take time for your body to get used to the new routine. This is why many people say they have tried "everything," without success. You simply may not have given it enough time. Try these tips tonight:

-- Make your bedroom noisy. What?! Yes, add in "white noise" such as from a fan, humidifier, or white noise machine (my favorite is the SleepMate). This helps to mask sudden changes in noise levels in the house due to talking in the living room or siblings moving around in the next bed. It really helps on vacation when noises might be different enough to keep kids up. Once we added this to our children's bedrooms, everyone began sleeping better.

-- Eliminate extraneous noise.  Some clients tell me that they want their children to learn how to sleep in noisy environments (or at least typical household noise), so they are reluctant to reduce sound levels.  You don't need to make your house the equivalent of a library, but some children (and adults) are more susceptible to frequent awakenings. If sleep trouble has been longstanding, it is more important to get back on track than to persist with a plan that's not working. When sleep has stabilized, then you can try re-introducing more typical levels of noise.

-- Keep Sparky out of the bedroom. Pets are cute and cuddly, but between barking, needing to be let out in the middle of the night, and trying to sleep on your pillow, they can really sabotage your sleep. Pets can also aggravate existing allergies, which makes sound sleep difficult. Instead, have kids sleep with a stuffed "Sparky" substitute.

-- Darker is better. Our eyes can detect light even when closed, and our brains respond to light by waking up. This keeps the level of "wakeful" hormones high, and "sleep" hormones low, preventing deep and restful sleep. Put in "blackout" curtains for deeper sleep and reduce early-morning awakenings. Turn bright clocks to the wall or keep them on the floor, rather than right beside you on the bedside table. Use only low-wattage night lights, and keep them in the hallway. If your child likes to fall asleep with a night light in his room, try turning it off after he is asleep.

-- End screen time 1 hour before bed. Computers, cell phones, TV, and video games all emit light at a wavelength that our brains interpret as daylight. Even if our teenager says that watching a video helps them to fall asleep, it is actually a very shallow sleep that is more easily disturbed. This is why it might be hard for your child or teen to get back to sleep if he awakens in the middle of the night -- the tv was turned off! It would be like having someone take our favorite pillow away in the middle of the night -- it would be hard to get back to sleep without it! Learning to fall asleep on our own is a skill that many of us need to learn. Give yourself (and your children) time to learn and practice this.


-- Get rid of all screens in the bedroom. Did you know that 20% of infants and toddlers have a TV in their room, and a whopping 43% of 3-4 year-olds do? Research has found a link between bedroom TVs and childhood obesity, inactivity, and low scores on reading and math tests. Research has also found that extensive viewing before age 3 may cause attention problems later. Give your child the opportunity to learn how to fall asleep on their own, without the crutch of TV to disrupt deep sleep.

-- Turn off cell phones after 10pm. Tweens and teens are bombarded with media at all hours of the day (and night). Many kids lose sleep because their phone is going off with Instant Messages, Tweets, and MySpace updates, literally all through the night. Social media is also a primary way that kids are being teased and bullied. Finding out at 11pm that someone is spreading a rumor about you is a sure-fire way to lose sleep. Make it easy on your middle- or high-schooler. Make it a household policy that kids give their phones to parents at bedtime, to be returned once they are ready for school (while you're at it, make all meals media-free so you can focus on family time).  Let them blame you to save face with their peers. Your daughter might say, "my mom is so mean, she takes my phone," but she'll have a good night's sleep under her belt for math class in the morning.

-- Have a bedtime routine. It's not just for toddlers any more. Having a set routine cues our brain, that big habit-forming machine that drives our body, to get ready for sleep the minute we see our jammies and a cup of herbal tea. Keep it short, simple, and make it workable. No point in trying to have a nightly bath if it's not something you can maintain.

-- Make your bed a sleep haven. Keep your bedroom free of work, bills, and other stress-inducers. Move your desk out of your bedroom, or put up a screen to separate your work space from your sleeping space. Read relaxing books instead of thrillers at night, and don't catch up on emails in bed. Don't use your bed as a workspace during the day either (pay bills at the kitchen table).  Finish difficult conversations with your spouse before getting in to bed (or plan to pick up the conversation tomorrow), and don't chastise the kids for today's wrongdoings as you say goodnight. End the day on a positive note.

-- Avoid caffeine for several hours before bedtime. This seems like a no-brainer, but did you realize that some herbal teas (green tea, white tea), root beer, orange soda, ice cream, and chocolate have enough caffeine to affect sleep? Some "energy" drinks also get their kick from the same caffeine that is in your espresso, not innocuous or short-acting "herbs."  Some people are affected by caffeine as much as 10 hours later. So try cutting off caffeine by 3pm, and move it back slowly until you find the right time for you. Click here for more caffeine counts in popular foods and drinks.

-- Avoid alcohol. While a beer or two might make you sleepy, it disrupts sleep later. In fact, alcohol actually increases the number of times you wake up at night. This is true regardless of your family history of alcoholism. Some people with insomnia may increase the amount of alcohol consumed, thinking that more alcohol means more sleep. However, the sleep-disrupting effects of alcohol actually increases the more you drink. So if you do imbibe, limit your consumption and keep it for the weekend (or a non-work day the following day). Click here for more information on insomnia and alcohol consumption.

-- Exercise: key to healthy sleep. Get 30 minutes of moderate exercise on most days of the week, and your sleep will improve.  Exercise regulates the brain chemistry responsible for healthy sleep-wake cycles, helping us to feel tired at night and wake up more refreshed in the morning. It also helps to reduce depression and anxiety, regulate bipolar mood cycles, manage hyperactivity, and reduce stress associated with chronic medical conditions. I advise regular exercise for all my clients, no matter their diagnosis or challenges they are working on. For best results, end exercise a couple of hours before bed.

-- Hydrate. About 60% of our body weight is water. If we don't drink enough, our body becomes sluggish and has trouble processing the foods, toxins, and stress that we take in during the day. Basic metabolic activity depends on it. Guidelines have recently been changed so that the old adage of "Eight, 8-ounce glasses of water a day" is no longer the golden rule. All non-alcoholic beverages count, including moderate intake of caffeinated beverages. Eating water-rich fruits and vegetables helps too. Drink more when the weather is hot, and when exercising. In general, women need about 9 cups of liquids per day, men about 13 cups.  Click here for the Mayo Clinics guidelines on staying hydrated.

-- Try a Worry Book. This can be helpful for people who can't get to sleep, or who wake up in the middle of the night with their mind racing. Write down those thoughts that won't let you sleep ("don't forget to send that email," "talk to my child's teacher"). Knowing that you won't forget and can address things in the morning can help you to get back to sleep. A variation of this technique is a Worry Box, where you mentally place your worries in to a box, and picture locking it. Open it up tomorrow, when you have the energy to face what's on your mind.

-- Tossing and turning? Get out of bed! If you have been awake for a while and can't get back to sleep, get up and try reading by a low-wattage, non-fluorescent light. Read something boring (like the refrigerator manual!), not something stressful, exciting, or too thought-provoking. Do not turn on the computer, TV, or check phone messages (remember those light waves wake us up!). Also avoid work, exercising or eating, all of which revs our metabolism. A small cup of herbal tea might help relax you, but don't drink so much that you end up needing a bathroom trip as soon as you've nodded off. When you feel sleepy, get back in bed (instead of falling asleep on the couch).

-- Try visualization, deep breathing, or progressive relaxation. These may be cliché, but they are also tried-and-true relaxation methods. Make this part of your bedtime routine, or try one of these methods when you wake up at 2am and can't get back to sleep. You can also try these tips in bed. Even if you aren't able to sleep, you will at least experience calm relaxation, which is restorative. Visualization can help you relive the relaxation you felt, say, on the beach. Focus on the senses to heighten visualization's impact (feel the sand in your toes, hear the waves crashing). Deep breathing is a way to slow down the heart rate. Breathe in through your nose for a count of 5, breathe out through your mouth for a count of 5. Repeat 5-10 times. With kids, I call these "balloon breaths," or I ask them to picture blowing out birthday candles. Progressive relaxation involves tightening first your toes for a count of 5 while breathing in, then release your toes while breathing out. Continue with all muscle groups of the body: legs, arms, shoulders, chest, abdomen, etc. Finish with a whole-body clench and release. Try one of these techniques next time you're stuck in traffic or waiting in line!

-- Melatonin. Ask your physician whether melatonin might be a supplement that is right for you. Melatonin is a hormone made by our bodies that helps regulate sleep and wake cycles, and it is found naturally in some foods. It may be helpful for people who work night shifts, who have Seasonal Affective Disorder, or who have difficulty falling and staying asleep.  See WebMD for more information on melatonin.

-- Get support. If you have chronic sleep trouble, or if your sleep has suddenly worsened and has not improved with these interventions, speak with your physician to rule out physical causes of sleep disturbances, such as sleep apnea, restless leg syndrome, allergies, asthma, heart disease, reflux, hyperthyroidism, certain medications, and other issues. If your physician has ruled out medical causes for your insomnia, get help with a trained psychologist who can determine if psychological causes are at the root of your sleeplessness. Depression, anxiety, ADHD, bipolar mood disorders, post-traumatic stress, sensory processing disorders, and other issues can significantly impact sleep. A psychologist can also help develop strategies to help you get a good night's sleep.

For more information, see The Sleep Foundation's website, and the University of Maryland's website.

Does My Child REALLY Need Therapy?

How do you know when your child needs therapy? Is it just a phase? Or is this odd, annoying, confusing (fill in the blank) behavior actually "normal"?

Step One: How Bothered Are You By The Behavior?
The first thing to think about when deciding if your child needs therapy is to check in with yourself, your spouse, your family:  How bothersome is the child's behavior? Does the behavior get in the way of the family's daily routines? Is learning or school participation affected? Are family members prevented from doing what they want or need to do? For example, does the child's difficulty organizing himself keep you from getting out the door on time? Is your child having such a hard time with social situations that you need to limit important family functions? Does the child's mood swings mean that you need to "walk on eggshells" around her? If you find that your family life consistently revolves around the needs or demands of one family member, at the expense of everyone else's goals, then now might be the time.

Step Two: How Bothered Is Your Child?
So OK, you and maybe the rest of the family are pretty bugged by your child's moods, quirks, or behavior. But what about your child? Does it get in the way of her happiness? Is she asking for help? My 6 year-old recently lamented to me that her clothes feel so terrible, that she can only wear one dress and one pair of shoes. We have known for a while that she had some sensory issues, where clothing, textures, and sounds can be irritating to her. It has been manageable, up to now, by helping her make choices, distracting her, and using the ubiquitous sticker chart to reward her for trying new pants in the winter. Yet it has quickly become very difficult for her, and today a) she felt terrible that "my skin wasn't letting me try," and b) she was sad she was going to be late for school, which she loves. Time to call an Occupational Therapist to deal with sensory processing issues. If your child isn't bothered, and the issue is manageable by other means, then perhaps a wait and see approach is appropriate. 

Step Three: Should You or Your Child Be Bothered?
Here is the reality check. Maybe your child isn't bothered, and maybe you aren't either. But should you be? Maybe your spouse thinks your child's tantrums in the grocery store are out of control, but you think they're no big deal. Or maybe your child's teacher has told you (again) that your son really should be "tested for ADHD," or that there are possible "learning issues." Even if you disagree, you owe it to your child and the rest of your family to make sure that you are not sweeping a big issue under the rug. First stop: the pediatrician's office. Come armed with questions, and take notes. And your child's teacher? Schedule a longer meeting and ask for details of her concerns. Talk to your child's coach, scout leader, or church youth group leader if the concerning behavior happens during those activities. You can also request a consultation with a child psychologist to determine if further evaluation or treatment might be warranted. A psychologist can hear both parents' viewpoints if you disagree, and help you decide the best course of action. 

Step Four: So Is This "Normal Kid Stuff"or something bigger?
In all things, there is a wide range of "normal." So to find out if your child's behavior is actually within the typical range for his age, check in with his pediatrician, teacher, daycare provider, and trusted websites (for a comprehensive list, see the Links on my website at www.LaurieFergusonPsyD.com). Weigh all the information and advice, and make a plan from there. 

Step Five: Weigh The Consequences Of Not Acting. 
So you've done your research, weighed your options, but you're still not convinced you need to do something "right now."  For example, you might not think that your child's reading difficulties are anything to worry about, "since he's only in second grade, he'll catch up." But your son's teacher is recommending testing.  Or maybe your pediatrician says, "I don't think your daughter has autism," but you still wonder if she is on the spectrum.  Keep in mind that early intervention has the best chance of success, particularly in the areas of developmental disorders (such as autism and asperger's disorder), learning, anxiety and depression management, social skills, behavioral problems, and sensory processing, such as my daughter has.  By not acting early, particularly in these key areas, your child could have a significantly more difficult time later. 

Step Six: Ok, We Need An Assessment Or Therapy Now.
First, call your insurance company and ask what your benefits are, including what your out-of-pocket costs would be. Ask for a list of providers in your area who specialize in working with children with, say, depression or autism. Ask for referrals from your pediatrician, and ask your child's teachers if they have recommendations. There are also community groups that can refer you to the proper specialist (see the Links on my website www.LaurieFergusonPsyD.com for many national organizations that offer referrals). Call the providers that are recommended and ask if they have experience working with the issues that your child is struggling with. Schedule a one-time consultation with the provider to see if their services are a good fit for your child. Some providers (including myself) offer a brief, complimentary consultation over the phone. 

Step Seven: Ask, Ask, and Ask Some More!
Ask everyone you speak with (psychologist, pediatrician, teacher) a lot of questions and don't be afraid to ask for resources, referrals, and information! Everyone who has a child's interests at heart is more than willing to provide this.  Good luck!

Client Privacy and What is HIPAA?

Below you will find Dr. Laurie Ferguson's Notice of Privacy Practices (Brief Version). Complete copies are provided to all clients.

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996, which was enacted to provide guidelines for how your health information can be used or shared.  For further information on HIPAA, go to http://www.hhs.gov/ocr/privacy/

Notice of Privacy Practices (Brief Version)

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

My commitment to your privacy
My practice is dedicated to maintaining the privacy of your personal health information as part of providing professional care. I am also required by law to keep your information private. These laws are complicated, but I must give you this important information. This is a shorter version of the attached, full, legally required notice of privacy practices. Please feel free to discuss any questions you may have.

How I use and disclose your protected health information with your consent
I will use the information I collect about you mainly to provide you with treatment, to arrange payment for my services, and for some other business activities that are called, in the law, health care operations. After you have read this notice I will ask you to sign a consent form to let me use and share your information in these ways. If you do not consent and sign the consent form, I cannot treat you. If I want to use or send, share, or release your information for other purposes, I will discuss this with you and ask you to sign an authorization form to allow this.

Disclosing your health information without your consent
There are some times when various laws require me to use or share your information. For example:
1. When there is a serious threat to your or another’s health and safety or to the public. I will only share information with persons who are able to help prevent or reduce the threat.
2. When I am required to do so by lawsuits and other legal or court proceedings.
3. If a law enforcement official requires me to do so.
4. For workers’ compensation and similar benefit programs.

There are some other rare situations. They are described in the longer version of my notice of privacy practices.

Your rights regarding your health information
1. You can ask me to communicate with you in a particular way or at a certain place that is more private for you. For example, you can ask me to call you at home, and not at work, to schedule or cancel an appointment. I will try me best to do as you ask.
2. You can ask me to limit what I tell people involved in your care or the payment for your care, such as family members and friends.
3. You have the right to look at the health information I have about you, such as your medical and billing records. You can get a copy of these records, but there may be a charge for this. Under some circumstances, you may not be able to see part of your record, for example, the notes that I may take during our therapy sessions. Contact me to arrange how to see your records. See below.
4. If you believe that the information in your records is incorrect or missing something important, you can ask me to make additions to your records to correct the situation. You have to make this request in writing. You must also tell me the reasons you want to make the changes.
5. You have the right to a copy of this notice. If I change this notice, I will post the new version in my waiting area.
6. You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with me and with the Secretary of the U.S. Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care I provide to you in any way. Also, you may have other rights that are granted to you by California laws, and these may be the same as or different from the rights described above. I will be happy to discuss these situations with you now or as they arise.

If you have any questions regarding this notice or my health information privacy policies, please contact me at the phone, address, or email noted above.

The effective date of this notice is March 2, 2010