Welcome to the Next Gen Therapy Family!

Next Gen Therapy is pleased to have you join us. We ensure that we are a highly inclusive, culturally sensitive, culturally respectful, and culturally competent organization. We will make every effort to ensure you are treated with respect and dignity at all times, in consideration of the following (but not limited to): racial, ethnic or cultural customs, practices, and beliefs; sexual orientation; gender, gender identity, and gender expression; disability, and community differences.

Further, Next Gen Therapy will take reasonable steps to ensure that those with Limited English Proficiency (LEP) have meaningful access and equal opportunity to participate in our services, activities, and programs.

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Applied Behavior Analysis is a scientifically validated approach to understanding behavior and how it is affected by the environment. In this context, “behavior” refers to actions and skills, and “environment” includes any influence - physical or social - that might change or be changed by one’s behavior.

Since the 1960’s, therapists have been applying behavior analysis to help children with autism and related developmental disorders. Early techniques often involved adults directing most of the instruction; however, some allowed the child to take the lead. Through the decades of research, the field of behavior analysis has developed many techniques for increasing useful behaviors and reducing those that may cause harm or interfere with learning.

On a practical level, the principles (how learning takes place) and methods of behavior analysis have helped many kinds of learners acquire a variety of different skills. One such principle is reinforcement. When the desired behavior is followed by a reward, the behavior is more likely to be repeated. Techniques used within ABA can be used in structured situations, such as a classroom lesson or “everyday” situations such as family dinnertime or the neighborhood playground. Therapy sessions can include one-on-one interaction or group instruction.

Applied Behavior Analysis strives to bring meaningful and positive changes in behavior- from healthier lifestyles to the mastery of a new language - from toddlers through adulthood.

Our team provides a range of services to help your child and your family. All programs are created from research-based strategies and developmentally appropriate curriculum. The teaching of treatment goals is done in a one on one or group setting in a natural environment (NET) and intensive teaching (ITT) settings. There is an emphasis on Verbal Behavior. These services include:

• One-on-one Settings
• Social Groups - small groups customized for your child, his/her goals, with his/her peers, and in his/her community

• Toy play
• Turn Taking
• Pretend/Imaginative Play
• Responding to Peers
• Cooperative Play

• Mand training (Requesting) American Sign Language (ASL)
• Picture Exchange Communication System (PECS)]
• Assistive Technology
• Vocal Speech
• Conversational Language
• Commenting
• Following Directions
• Decrease problematic behavior by teaching increasing functional language skills and teaching replacement language.

• Requesting (this includes vocal and non-vocal)
• Following instructions
• Expressively identifying items
• Visual perceptual skills
• Motor imitation
• Play skills
• Answering questions
• Activities of daily living
• School readiness skills
• Social skills

Functional Behavior Assessment: Functional behavior assessments determine why a behavior is occurring. If we know why a behavior is occurring we can then design an intervention to teach a replacement behavior that will get the same reinforcement that is maintaining the behavior. Functional behavior assessments are conducted by the BCBA and can include any of the following.

• Direct observation of the behavior: We may watch behavior in the clinic or where the behavior is occurring such as home or school.
• Indirect assessments: Indirect assessments are filled out by someone who knows the child. These assessments are sometimes like rt scales or open-ended questions. The BCBA will then review this data and see if they can hypothesize a function.
• Functional Analysis: A functional analysis is the last step of a behavior assessment. A functional analysis is also called an experimental analysis of behavior. This is where different conditions are presented in a controlled fashion to determine the most likely function. Functional analyses yield very valuable information as to why a behavior is occurring and can save the behavior analyst time in designing a function based intervention since they will have found a probably function during the analysis. A functional analysis will not be performed without your consent.
• Behavior Intervention Plan: Behavior Intervention Plan (BIP) takes the observations made in an FBA and turns them into a concrete plan of action for managing a child's behavior. A BIP may include ways to change the environment to keep behavior from starting in the first place, provide positive reinforcement to promote good behavior, employ planned ignoring to avoid reinforcing bad behavior and provide supports needed.

VB-MAPP, ABLLS-R, AFLS, PEAK, parent/ teacher interview & observation, social skills inventory, reinforcer inventory, and other developmental checklists. Assessments are used to guide program development. They are NOT used to diagnose.

The intensive toilet training procedure is a researched based procedure with several components that will help jump start your child’s success at toilet training. Intensive toilet training is conducted under the direction of the BCBA, with a behavior tech, and with the parent. The BCBA will monitor sit and drink schedules while also training the parent on how to continue the toilet training procedure. The tech will help the parent assist the child to the toilet during the sits. This procedure is conducted over two days and parent participation is required for both days. It is recommended that toilet training be conducted on Thursday/Fridays so that the parents can continue toilet training over the weekend. On Monday morning you will follow up with your BCBA and they will help you determine a plan of action moving forward.

This includes ongoing assessments, data compilation, task analysis, program updates, reports, review any given documents, development of treatment plans, and sometimes direct instruction training program management. A description of the completed program development tasks, including time spent, during each month will be attached to the invoice each month. Time needed for program development is 4 hours each month. This time can be in addition to the weekly allotment of hours or can be done in place of a session. Please note that prices for program development are different from session prices. Program Development allows us to review your child's progress, research, and update any new plans your child may need.* This service is not optional. It is mandatory with any other service.

Family trainings are trainings provided to the family to help the family continue the treatment plan at home or to help the family with anything they want help with at home. Family trainings are provided by the BCBA (and a behavior tech if needed) and can occur in clinic or in the community. At Next Gen Therapy we want your child to make progress that is meaningful to you, so we value your input in knowing what is important to you and ask that you help us in choosing what the focus of your family training is. Examples of family training may include:

• Direct observation of the behavior: We may watch behavior in the clinic or where the behavior is occurring such as home or school.
• Indirect assessments: Indirect assessments are filled out by someone who knows the child. These assessments are sometimes like rt scales or open-ended questions. The BCBA will then review this data and see if they can hypothesize a function.
• Learning strategies to help your child while grocery shopping
• Requesting at home
• Sibling relationships
• Eating non-preferred foods (provided there are no sensory issues diagnosed by an OT).
• Learning your families customs (eg how to trick or treat for Halloween, how to wait for their name at Christmas time when opening presents).
• Helping your child learn to sit through meals at the restaurant or home

Next Gen Therapy follows the Behavior Analyst Certification Board (BACB) guidelines. Within these guidelines, clients have the right to effective behavior treatment, which includes individual’s rights, professional relationship and informed consent.

• A therapeutic environment
• Services whose overriding goal is personal welfare
• Treatment by a competent behavior analyst
• Programs that teach functional skills
• A behavioral assessment and ongoing evaluation
• The most effective treatment procedures available

• Confidentiality
• Protecting the client's dignity, health, and safety
• Helping the client select outcomes and behavior change targets
• Maintaining records
• Advocating for the client
• Providing necessary and needed services
• Evidenced-based practice and least restrictive alternatives
• Not a conflict of Interest

Informed consent means that the potential recipient of services gives his/her (in our case the parent/ guardian) explicit permission before any assessment or treatment is provided. Informed consent requires more than obtaining permission. Permission must come following full disclosure and information is provided to the participant. For consent to be valid:

• Person must demonstrate the capacity to decide
• The person's decision must be voluntary
• The person must have adequate knowledge of all salient aspects of the treatment.

More information can be found at www.BACB.com

Director of Clinical Services: The Director working with the BCBA, designs and develops all the teaching programs and sets priorities for your child’s intervention program based on the goals that have been set for your child and family. The Director can also coordinate services with other providers your child may see if you desire.

BCBA/BCaBA: The BCBA/BCaBA serves as the primary contact person for your family and the professionals working with your child. The BCBA/BCaBA will help the Director ensure that the ABA Therapists are very well trained and that they implement your child's program as the Director prescribes. The BCBA/BCaBA reviews charts/data showing your child's progress, and lEPs. In addition to attending monthly team meetings, the BCBA/BCaBA always has up-to-date information concerning your child's progress. Additionally, because the BCBA/BCaBA also implements your child's intervention program with your child at least once each month, they are also able to provide you with important and useful information that will inform treatment decisions concerning your child's progress. In the case that a BCBA/BCaBA is not available, the above roles and responsibilities may be split between the Director and the Line Therapists.

ABA Therapists: The ABA Therapist works with your child several times each week and is fully trained by Next Gen Therapy. The ABA Therapist ensures that the Director and BCBA/BCaBA have all the information they need to manage your child's program effectively.

Everyone works together to make sure that your child is receiving the best possible program based on individual goals. Duties and responsibilities of team members may vary and are not limited to the roles as stated above.

There is no guarantee that the same therapist/BCBA will be assigned to your child's case for the entire time you receive services at Next Gen Therapy. Next Gen Therapy may change staff assigned your child's case at any time as needed.

I acknowledge that my child’s therapist team may change at any time.

Parents acknowledge that each client receiving services from Next Gen Therapy has an individualized treatment plan (ITP). Each program is developed after assessments are completed; both direct and indirect. Each program is continually evolving based on the child's progress. The Director is ultimately responsible for making programmatic decisions. Parents will be notified of any changes and discussions that may take place. Therapists are not allowed to change the program without the Director’s approval.

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Communication

Communication is a vital role for many several reasons. Our goal at Next Gen Therapy 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 replying 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, email, call or text to indicate when you will be able to respond so that we are aware that you received the communication.

*Business hours are from 8:00am to 7:00pm Monday-Friday

Please contact Nicole Bell at nbell@mynextgentherapy.com for all questions. For complaints you can use our form at https://mynextgentherapy.secureformsubmit.net/FillOutForm.aspx?formname=Client_Complaint.

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Confidentiality Policy

Next Gen Therapy provides direct services to clients and their families. Consequently, we are dealing with health information on a daily basis. Next Gen Therapy is bound by HIPAA regulations that require organizations to protect the sensitive health information of their clients. Protected Health Information (PHI) includes "any information, whether oral or recorded in any form or medium" that "relate(s) to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual." Therefore, to ensure the confidentiality of every client that we treat, we have developed certain standards of care that employees must be aware of and agree to.

Employees acknowledge the following policies about clients, employees will never disclose or discuss protected health information, client care, programming, client name, etc. with anyone who is not employed by Next Gen Therapy; employees will take every precaution to ensure that data sheets, log books, or other sensitive documents that could reveal a diagnosis is protected (e.g., in a locked filing cabinet and always on their person when not under lock and key); employees will never communicate or publish protected health information of clients including names and images in physical or electronic form without prior written consent of the client and Next Gen Therapy..

All records, including but not limited to medical and psychological reports, videotapes, DVDs, photographs, voice recordings, data and information related to the client ("Confidential Information") are the property of Next Gen Therapy. Team members should not disclose any Confidential Information to any person or use any Confidential Information for the benefit of the team member or any other person, except with the prior written consent of the Next Gen Therapy.

Due to the sensitive nature of information, it is imperative thatNext Gen Therapy keeps sensitive information confidential. Any information about your children or family will be shared on a "need to know" basis only. Thus, Next Gen Therapy is very sensitive about discussing your child's developmental needs and your family information in public places. Your client information will not be left unattended at any time (i.e., session notes, data sheets, binders). All devices (i.e., phones, iPads, computers) have auto-lock and password enabled at all times. In the case that a device is missing or stolen the team member will notify the director immediately. Next Gen Therapy has the capability of erasing all its electronic devices to avoid a breach of sensitive information. Your client information will not be shared on any forms of social media sites. Emails containing sensitive information sent outside of the Next Gen Therapy network to authorized professionals will be password protected.

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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.

Next Gen Therapy must to maintain the 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 the Release of Information Form, Next Gen Therapy 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, Next Gen Therapy must provide information to the funding source being used.

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Mandated Reporter Disclosure

All behavioral staff members for the in-home program operated by Next Gen Therapy are mandated reporters as deemed so by Michigan state rules, regulations, and laws. This is true of all social workers, teachers, etc., and should not restrict the work to be completed. This is a state 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 the client information packet.

Being deemed a mandated reporter, the Behavior Therapist for the Next Gen Therapy program is required by law to report any and all allegations, reports, and suspicions of child abuse, neglect, and maltreatment to the appropriate identified governing body.

Child Protective Services is the governing body identified in the state of Michigan regarding cases of child abuse, neglect, and maltreatment, and the Behavior Therapist is required and shall, therefore, report the incidents mentioned above to the National Hotline for Child Protective Services. Any report to Child Protective Services, where deemed necessary by them, shall constitute a separate case from the one managed by Next Gen Therapy intensive in-home and center based program. For this reason, it should be noted that the behavior staff shall only participate in CPS cases as required and requested by Child Protective Services. The intensive in-home program operated by Next Gen Therapy shall play no part in decisions made by Child Protective Services and should be viewed as a separate organization from Child Protective Services.

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

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Schedules

Cancellations or request to re-schedule a session must be made at least 24 hours before the start of your scheduled session. If you fail to give 24 hours’ notice, you will be charged $60.00 for each cancelled appointment. The penalty does not apply in the case of illness or inclement weather. If for any reason (other than sudden illness) the client needs to end a session early, the remaining time qualifies as a less than 24-hour cancellation and may be billable. Insurance carriers are not responsible for missed appointment fees.

In the case of a cancellation with less than 24 hours’ notice, immediately contact nbell@mynextgentherapy.com and follow up with a phone call to the therapist who would be working the session.

If for any reason you are running late for a session, please notify the therapist scheduled and send an email to nbell@mynextgentherapy.com as soon as possible. The therapist will wait for up to 15 minutes. Please note your full session may not be met because other clients may be scheduled after your session. This would count as a ‘less than 24-hour fee’ and the full cost of the session may apply.

To request a general schedule change or to discuss any scheduling concerns, send an email to nbell@mynextgentherapy.com. We request that families give us at least two weeks’ notice on significant changes in their plans for in-home ABA sessions scheduling, to facilitate consistency in service delivery.

If your child's session will be canceled or rescheduled by Next Gen Therapy, 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 tardiness. We may need to re-evaluate schedules (re: drive time, traffic, time of day, etc.).

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Wellness Policy Statement of Understanding

To minimize the spread of illness, if the child displays one or more of the following symptoms, they are required to inform the staff immediately to reschedule their therapy session (24-hour cancellation fees do not apply.)

• Vomiting/Diarrhea
• Temperature greater than 100 degrees
• 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.


The client 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 have passed, and the client is well enough to resume normal activities. If the client becomes ill during a session, the session will be immediately cancelled. Parents agree to notify the staff within 24 hours of the diagnosis of a serious contagious illness or parasitic infestation.

We follow the guidelines developed by the American Academy of Pediatrics and the American Public Health Association. Parents who repeatedly fail to follow policies related to keeping children at home when they are ill may lead to dismissal from the program.

Please notify the Therapist or Director 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 canceled due to an illness of a staff member, you will be contacted immediately.

Infectious Diseases:When a communicable disease has been introduced into the clinic, parents will be notified. The clinic also will report these occurrences to the state and local health departments when required. Parents are urged to notify the clinic when their child is known to have been exposed to a communicable disease outside the clinic.

The Lead BCBA or Clinical Director may determine that a child who does not appear to be fully recovered from an illness cannot be readmitted to the clinic without a statement from a physician stating that the child can return and participate in the activities of the clinic or is no longer infectious.

We reserve the right to refuse care due to illness.

In the case of impetigo, lice, ringworm, pinworms, rashes, chicken pox, thrush, etc., your child must be NON-CONTAGIOUS before returning to the clinic.

Injurious Behavior: If at any time a child engages in injurious behavior to staff, his/herself, or other children, the Lead BCBA or Clinical Director is notified, and an incident report is created. The Lead BCBA or Clinical Director will decide how best to minimize the potential harm to the child, staff and others. In some cases, the child can be removed from a group setting to a more traditional one-on-one therapy session. The Lead BCBA or Clinical Director may reintroduce the child into the group setting at the point in time it is determined that the child needs more direct assistance. The parents will be notified of the change in treatment and any appropriate options that can be offered to remain in the group. If the Lead BCBA or Clinical Director feels there is a possibility of serious harm to the child or others, the parents will be contacted to pick up the child as soon as possible.

Injurious behavior may lead to dismissal from the program for the safety of the client(s) and or staff.

Medical Emergencies: When a medical emergency arises, every effort will be made to contact parents, guardians, or an emergency contact. If parents or emergency contacts cannot be reached, the Director and Lead BCBA will decide the next step, which may consist of calling 911. In an extreme emergency, the staff member may, at their discretion, call 911 before contacting the parent or guardian of the child. An authorized representative from the clinic will accompany the child and remain with him/her until their caregiver arrives. Our emergency information form, filled out at the time of enrollment, serves as consent for your child to be transported by ambulance to a local medical facility to receive emergency care. Next Gen Therapy assumes no responsibility for the costs associated with emergency care. Next Gen Therapy staff do not transport children to medical facilities at any time.

All staff receives training in CPR, first aid, fire, flood, and tornado procedures.

Medications: Next Gen Therapy does not administer prescription medications of any kind. If your child needs any medication during the session, a parent or guardian must come back and administer it.

Pandemic: In the event of a pandemic in our area, Next Gen Therapy may close for an undetermined amount of time to ensure prevention of further spread of disease. We will follow any requirements issued by the Department of the Public Health.
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Pets and Animals

Next Gen Therapy recognizes that some workers are either allergic to or afraid of certain animals; and, to prevent unpredictable behaviors or situations, we ask that you keep your pets in a secured separate room, space or area, or outside during all home visits. This policy is not dependent on the animal’s behavior or the therapist’s comfort level, but as a universal policy to ensure the safety of all Next Gen Therapy staff.

Under no circumstance can the animal come near the therapist during the visit; this includes upon arrival and departure.

This policy refers to, but is not limited to: dogs, cats, birds, snakes, reptiles, rabbits, rats, hamsters, guinea pigs, etc.

This policy excludes service animals.

In the case of non-compliance, the therapist will immediately leave the premises and notify the Supervisor or Director and will not be able to return until this policy is adhered to. If there are repeated non-compliance issues, or the client is unable to follow this policy, then other arrangements will be made for sessions outside of the home.

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Aggressive Behavior

Next Gen Therapy employees have the right to work and provide services in a safe environment that supports personal worth and dignity through mutual respect, cooperation, and understanding. As such, Next Gen Therapy will not tolerate any violent or aggressive behavior, discrimination or harassment towards any of our workforce members.

Any adults in the home are expected to treat staff working in their home with dignity and respect and Next Gen Therapy will not tolerate behavior that would be considered offensive, intimidating, sexual, or unwelcome in any way.

Violence and aggression, such as physical force, threatening behavior, or verbal abuse are strictly prohibited toward the staff, Client, or other members or animals within the household. If the staff member feels that they or anyone else is subjected to violence, harassment or discrimination in any way, they will leave the premises at once and immediately notify the Supervisor or Director who will then notify appropriate authorities if necessary. If an investigation confirms the staff member’s perceptions, Next Gen Therapy may have to discontinue service.

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Smoking

Smoking in a place of work poses serious health risks and fire hazards to workforce members. It is the employer’s duty to ensure a safe, smoke-free environment for all staff members.

During support services with Next Gen Therapy ’s therapist, the client’s home automatically becomes a workplace for the duration of the visit. As such, smoking inside the home is strictly prohibited during, and at least 15 minutes before the provision of services. The term smoking includes, but is not limited to: cigarettes, tobacco, marijuana, e-cigarettes, pipes, etc.

In the case of non-compliance, the therapist will immediately leave the premises and notify the Supervisor or Director and will not be able to return until this policy is adhered to. If there are repeated non-compliance issues, or the client is unable to follow this policy, then other arrangements will be made for sessions outside of the home.

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Illegal Activity

During support services with Next Gen Therapy ’s therapist, the client’s home automatically becomes a workplace for the duration of the visit. As such, any illegal activity inside the home is strictly prohibited during the provision of services. The term illegal activity includes, but is not limited to sale, possession of, or taking of illicit controlled substances, vandalism, prostitution, theft, assault, etc.

In the case where the therapist witnesses illegal activity in the client’s home, the therapist will immediately leave the premises and notify the Supervisor or Director, who will then notify the appropriate authorities.

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Temperature Control

During support services with Next Gen Therapy ’s therapist, the client’s home automatically becomes a workplace for the duration of the visit. As such, we ask that you respect the therapist’s physical comfort level and ensure that the home is neither too hot, nor too cold during the duration of the visit. Between 68 degrees Fahrenheit (summer) and 74 degrees Fahrenheit (winter) is a comfortable temperature range to use as a reference point.

In the case of non-compliance, the therapist will notify the Supervisor or Director and will not be able to return until this policy is adhered to. If there are repeated non-compliance issues, or the client is unable to follow this policy, then other arrangements will be made for sessions outside of the home.

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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 when traveled in. Examples of inclement weather can take many forms and can include, but should not be limited to the following:

• Unplowed snow covered roads, roads inadequately plowed, or icy roads
• Flash flood warnings, or flooded areas
• A dangerously low chill factor
• Excessively high temperatures, or high heat index
• Poor air quality warnings
• Severe thunderstorm warnings, tornado warnings, or sightings for a related area.

The Next Gen Therapy staff will make any decisions regarding the weather and safety risks 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 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 do not exclude the dangers present in the areas that must be traveled 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 Next Gen Therapy staff will follow the county school cancellations for the county in which you or the staff resides. If the staff believes they can continue with the scheduled appointment, they will notify you to confirm the session. Sessions are difficult to reschedule given the times in which families are available, however, the staff will make all efforts to make accommodations. Please keep in mind that other regularly scheduled appointments may interfere with rescheduling on another day.

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Parent Participation

Parents are integral to the success of each child. Next Gen Therapy strives to include parents in all aspects of therapy from goal and objective development to treatment strategies and behavior management skills. The consistency of programming across settings is our ultimate goal. The Next Gen Therapy team members are available to train parents in the areas of behavior management and the application of intensive teaching procedures in the hopes that parents will also become part of the child’s therapy team.

The level, intensity, and frequency of parent training will be included in your child’s Individualized Treatment Plan (ITP).

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Procedure for Lack of Participation

The following is an explanation of the steps that will be taken if a parent/guardian is not participating in their child’s programming.

1. The first time that a parent or guardian does not meet one of the participation requirements, the consultant will provide the parent or guardian with a verbal warning and follow up with an email reminding the parent or guardian of participation requirements. The consultant will explain clearly to the parent or guardian where their participation is lacking. The consultant will offer more training if this is part of the issue.
2. The second time that a parent or guardian does not meet one of the participation requirements, the consultant 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. The consultant will offer more training if this is part of the issue.
3. The third time that parent or guardian does not meet one of the participation requirements, the consultant 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 case manager and consultant 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 on the grounds that Next Gen Therapy cannot provide effective treatment if the parent or guardian is not participating in the child's programming. 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.

The Director and ABA therapy team will work closely with every parent or guardian 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 behaviors.

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Parents’ Interaction with Staff & 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 therapeutic one is completely inappropriate.

Dual relationships include, but are not limited to babysitting, acting as a nanny, bartering of services of goods, friendships, sexual relationships, etc. This pertains to past and present employees. Next Gen Therapy strives to hire the best staff; however, at times people may leave our company for various reasons. In this case, we 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 about why a staff member left the company. This is for the protection of Next Gen Therapy and for our clients.

Parents acknowledge that Next Gen Therapy does not ever allow employees to transport clients or client family members.

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Gifts

Next Gen Therapy’s employees, volunteers or workforce members may not accept any gifts of any kind in connection with their service to Next Gen Therapy .

• Money
• Any item of value, service, loan, thing or promise
• Discount or rebate for which something of equal or greater value is not exchanged
• Payments for travel, entertainment, and food

• Handmade items by and from children, such as a drawing or painting
• Edible gifts of nominal value (less than $10) that are shared with a wide range of colleagues at Next Gen Therapy
• Any discount or rebate made in the regular course of business and offered to the general public without regard to the individual’s connection with Next Gen Therapy

If an employee or workforce member receives a gift prohibited by this policy, the gift giver will be reminded of this policy and the employee will graciously decline or return the gift. If the gift is anonymous, the recipient must deliver the gift to the Director, who will convey the gift to a charitable organization.

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Agreement to Videotape - Audiotape - Photograph

Next Gen Therapy staff may take photographs or videotapes for marketing, education, or training. Parents acknowledge that they and their child may be photographed or videotaped during a session. Parents give Next Gen Therapy permission to use their image at any point in the future for the purposes of marketing and training. Videos and pictures will ONLY be taken with Next Gen Therapy equipment. Next Gen Therapy Staff are not allowed to record any videos, pictures, or audio using his or her personal equipment. Clients/Parents must receive written permission from Next Gen Therapy before videotaping portions of sessions or taking pictures of Next Gen Therapy staff.

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Resolving Grievances

We encourage the client to discuss any matter of concern regarding the services delivered by Next Gen Therapy staff with the BCBA 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, and the designated management staff to assist in reaching a satisfactory resolution.

If you feel like the issue/concern has not been resolved, please fill out a formal complaint at Next Gen Therapy Complaint Form.

Within two (2) business days of receipt of a written complaint (Via email, letter or the Client Complaint Form), the Director of Operations will respond.

In the event there is not a satisfactory resolution reached with the Director of Operations, the client may appeal the matter to the Director of Clinical Services.

Within five (5) business days of an appeal, the Director of Clinical Services will contact the Client with the final resolution. If the client is still not satisfied, they have the right to refuse services, contact their insurance company/case manager (if applicable), or contact local, state, or federal government agencies.

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Service Agreement and Consent Form

This document contains important information about our professional services and business policies. Your signature(s) below indicates that you have read the information in this document and agree to be bound by its terms and that you have received the Notice of Privacy Practices and Mandated Reporter forms. Consent by all parents/legal guardians (those with legal custody) is required.

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Financial Responsibility Agreement

1. An ABA Therapist (trained and supervised closely by the BCaBA and BCBA must conduct at least 50% of all therapy sessions.
2. Payment must be received on or before the due date as written on the invoice (within 30 days from the date of the invoice).
3. All documents must be signed and returned within 72 hours of receipt. If additional time is required, please discuss this with a Next Gen Therapy team member.

Financial Responsibility Agreement

• There is a $40.00 Returned Check Fee for all checks returned by the bank.
• Appointments must be canceled at least 24 hours in advance. If they are not canceled with 24 hours’ notice, you will be charged a $60.00 missed appointment fee.
• There is a late Payment charge of $60.00 as described above.
• Any requests for printed records will take up to 30 days and cost a flat fee of $20.00

ABA Therapy Service Agreement

During the term of this agreement, Next Gen Therapy will provide ABA Therapy services, and the parents/guardians will compensate Next Gen Therapy a payment for the services as described below in the terms and conditions specified. I understand all the fees and conditions as stated above.

• Behavioral treatment services, which may include, but are not limited to: direct one-on-one instruction, a continuation of assessments, and modification of programs (data review), completion of Functional Behavior Analysis (FBA) or Functional Behavior Analysis for problem behaviors, an update of Behavior Intervention Plan (BIP), and parent training.
• Other professional services can be requested but are not included in this service agreement may include, but are 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

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Nonviolent Physical Crisis Intervention Release

Next Gen Therapy utilizes Nonviolent Crisis Intervention provided by Crisis Prevention Institute as a crisis management system. All staff that may be involved in physical intervention are trained and certified in Nonviolent Crisis Intervention. Please be aware parents cannot be trained by our staff in personal safety techniques and physical interventions (i.e., restraints). Nonviolent Crisis Intervention's philosophy is Care (showing compassion and empathy); Welfare (supporting emotional and physical well-being); Safety (preventing danger, risk, and injury); and Security (ensuring harmony-not harm). The focus of Nonviolent Crisis Intervention is on the client and emphasizes the importance of being supportive and maintaining therapeutic rapport. All staff have been trained to understand the levels of crisis development, how each level of crisis should be approached, and how to proactively prevent any need to use physical intervention by teaching replacement behaviors.

Nonviolent physical crisis intervention is the safe, non-harmful control and restraint positions to safely assist an individual until he/she can regain control of their behavior. Physical management will only be utilized as a last resort when all other less restrictive strategies have been exhausted, or when a person is considered a danger to self or others, according to the procedures provided by QBS Safety-Care per policies established by Next Gen Therapy. A serious incident will be documented in a written report and reviewed with the parent/guardian/ witnesses. The report will be submitted to the Director of Operations and placed in the client's file.

When addressing problem behaviors, client's care, welfare, safety, and security will be our primary focus. Nonviolent Physical Crisis intervention will always be a measure only used to ensure the safety of clients and others. If you have any questions or concerns regarding this policy, please contact Next Gen Therapy at any time.

If you choose to decline the use of physical intervention, it will be assessed by the Next Gen Therapy staff including, at minimum, the executive director, supervisor, and therapist the level of risk in the home and if services can continue to be provided safely without the use of physical intervention.

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Please answer each Question below.There are no right or wrong answers.

My Child's Strengths

My Child's Areas Of Need

Medical History:

Birth History:

Health review: Please check any that apply. Please leave a comment if applicable.

Skin:

Medications: Please list all prescription and non-prescription medication, including vitamins and herbals, with name, strength, how often you take them, and when they were started:

Family History: Please check if your child’s parents, grandparents, aunts/uncles, siblings, or cousins have/had any of the following (indicate which family member):

Social History: