Professional Disclosure Form for Lisa L. Adams, M.S., LCMHCS, LCAS-Therapist
336-937-0331
[email protected]
This document is a part of the Standards of practice of the North Carolina Board of Licensed Clinical Mental Health Counselors. (NCBLCMHC) as stated in section 90-343 of the LPC Act. It is designed to inform you my professional qualifications, counseling philosophy and most importantly, your rights. Please take the time to read and sign this document prior to accepting services. Also, please feel free to ask any questions that you may have.
Education & Experience
I am a licensed Clinical Mental Health Counselor Supervisor (LCMHC #S4933) and have been licensed with the Board (NCBLCMHC) since 5/20/2005. I am also licensed as a Clinical Addictions Specialist (LCAS #1785) since 2/25/2011. I have just over 16 years of post-licensure experience in the field of behavioral health. My clientele has included adults, families and at-risk adolescents and children. I have worked with individuals, with PTSD, anxiety, depression, trauma, substance use, anger, stress management and relational problems and have individual, group and family counseling experience. I also have a number of years’ of experience working with individuals who struggle with serious and persistent mental illness and/or substance use disorders. Since being fully licensed as an LCMHC, I became credentialed as an LCMHC Supervisor on 5/25/2016.
Counseling Philosophy
I believe that a strong and healthy therapeutic relationship is essential for there to be significant gains made towards recovery and that counseling is a collaborative process. My role as a counselor is to act as a catalyst, provide support and a safe place for clients to examine their life and areas of need for change and growth. In utilizing a holistic approach, treatment efforts are directed at making sure that starting with the basics the client’s needs are met ensuring that they have the foundation needed to support recovery. I have experience providing individual, family and group counseling and have worked with all ages from children to geriatric. The reasons why individuals seek counseling are varied and to meet these needs I utilize and pull from various best practice treatment modalities and evidenced based practices in which I have been trained. These include cognitive behavioral therapy, person-centered therapy, motivational interviewing, dialectical behavioral therapy and other structured brief therapy approaches. I am a trained and licensed addictions counselor and I also have training in suicide prevention (QPR, certified trainer), critical Incident stress management (CISM), trauma, secondary traumatic stress, and trauma-informed care approaches which I integrate into my practice of counseling.
Fees and Insurance Reimbursement
At Soul Care, LLC the standard fee for service are as follows:
Comprehensive Clinical Assessments (CCAs) = $125.00
Follow up counseling sessions = $110.00
Soul Care does offer a sliding fee scale based on income.
Diagnosis
In the event that services provided are billable to insurance, it should be noted that health insurance companies require that a diagnosis of a mental-health condition be indicated before they will agree to reimburse for counseling services. If a qualifying diagnosis is appropriate in your case, I will inform you of the diagnosis before it is submitted to the insurance company. Any diagnosis made will become part of your permanent records.
Confidentiality
I will not release any information about you to any person or agency without your written consent except as noted below:
As a Licensee of the NCBLCMHC, I will abide by its Code of Ethics. To maintain my license I am required to participate in frequent continuing education, taking courses with subjects relevant to this profession. I also participate in supervision and consultative activities with other licensed therapists and counselors in order to support my work with clients. Any information shared during the supervision is discussed for professional purposes only.
All information shared will be kept confidential while receiving services with the following exceptions:
a) The requirement to report any suspected child or elder abuse or neglect, to the relevant authorities.
b) If you are believed to be an imminent threat to you yourself or others
c) If you give me written permission to disclose information.
d) Reporting information required in court proceedings, if court ordered to do so.
e) If you desire to seek reimbursement from managed care, insurance company, or other relevant agencies, release of confidential information may be required for reimbursement.
f) In the case of a medical emergency.
g) Providing information concerning licensee consultation or supervision.
h) Defending claims brought by client against licensee
Even under these circumstances only essential information will be shared and as much as possible you will be informed before confidentiality is broken. In the event that the client is a minor, parents or guardians may be included in the counseling process as is appropriate, and always acting in the best interest of the client.
Telehealth Counseling
Telehealth Counseling is similar to face to face counseling, except sessions are conducted either over the
telephone or over the internet using software that can be downloaded to your computer or mobile device.
Although face to face counseling is the preferred approach for conducting therapy, electronic forms of counseling
can provide therapy services for clients that have extenuating circumstances.
Forms of Telehealth Counseling: I currently offer internet and telephone counseling:
Benefits/Limitations of Telehealth: Counseling As stated earlier, electronic forms of counseling can be a
helpful alternative approach to traditional, face to face counseling, however, there are some limitations that could
impede the therapy experience.
How to contact me:
Ø When not in session, you can call me at 336-937-0331. This is a confidential voicemail.
Ø You can also text or email me. Email should not be used for appointment cancelation.
Ø If you are experiencing a life threatening emergency, please call and dial 911 or go to the nearest emergency room.
Ø I can be reached by phone for quick questions or appointment changes.
Ø In case of an emergency, please provide an emergency contact to the Front Office if not included with your Client Registration. You may call us at 980-613-8312 -OR- email it to [email protected] -OR- fax it to 888-972-4998.
Termination
The end of therapy can happen for a number of reasons:
Ø The natural ending of the counseling relationship. We will talk about the end of therapy from the beginning. We will discuss the ending process and start meeting less often to help with termination. At the last session, we will go over a termination agreement with suggestions on what to do so you can continue to thrive without counseling.
Ø If you feel your needs are not being met. We can reevaluate goals and see if it helps. If not, I can refer you to someone else. Please do not just stop coming. Allow me to help you find the best counselor for you.
Ø If it appears that I am not the best fit as a counselor for you, I will discuss it with you and will refer you to someone else.
Ø Services will also be ended, if you miss two (2) scheduled appointment in succession without any notice.
Filing Complaints
If we are unable to resolve difficulties or if at any time you feel that I have treated you unfairly, unethically or have violated your rights in some way, you do have the right to state your concerns to the board at:
North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC)
P.O. Box 77819
Greensboro, NC 27417
Phone: 844-622-3572 or 336-217-6007
Fax: 336-217-9450
E-mail: [email protected]
https://www.ncblcmhc.org
[email protected]
This document is a part of the Standards of practice of the North Carolina Board of Licensed Clinical Mental Health Counselors. (NCBLCMHC) as stated in section 90-343 of the LPC Act. It is designed to inform you my professional qualifications, counseling philosophy and most importantly, your rights. Please take the time to read and sign this document prior to accepting services. Also, please feel free to ask any questions that you may have.
Education & Experience
I am a licensed Clinical Mental Health Counselor Supervisor (LCMHC #S4933) and have been licensed with the Board (NCBLCMHC) since 5/20/2005. I am also licensed as a Clinical Addictions Specialist (LCAS #1785) since 2/25/2011. I have just over 16 years of post-licensure experience in the field of behavioral health. My clientele has included adults, families and at-risk adolescents and children. I have worked with individuals, with PTSD, anxiety, depression, trauma, substance use, anger, stress management and relational problems and have individual, group and family counseling experience. I also have a number of years’ of experience working with individuals who struggle with serious and persistent mental illness and/or substance use disorders. Since being fully licensed as an LCMHC, I became credentialed as an LCMHC Supervisor on 5/25/2016.
Counseling Philosophy
I believe that a strong and healthy therapeutic relationship is essential for there to be significant gains made towards recovery and that counseling is a collaborative process. My role as a counselor is to act as a catalyst, provide support and a safe place for clients to examine their life and areas of need for change and growth. In utilizing a holistic approach, treatment efforts are directed at making sure that starting with the basics the client’s needs are met ensuring that they have the foundation needed to support recovery. I have experience providing individual, family and group counseling and have worked with all ages from children to geriatric. The reasons why individuals seek counseling are varied and to meet these needs I utilize and pull from various best practice treatment modalities and evidenced based practices in which I have been trained. These include cognitive behavioral therapy, person-centered therapy, motivational interviewing, dialectical behavioral therapy and other structured brief therapy approaches. I am a trained and licensed addictions counselor and I also have training in suicide prevention (QPR, certified trainer), critical Incident stress management (CISM), trauma, secondary traumatic stress, and trauma-informed care approaches which I integrate into my practice of counseling.
Fees and Insurance Reimbursement
At Soul Care, LLC the standard fee for service are as follows:
Comprehensive Clinical Assessments (CCAs) = $125.00
Follow up counseling sessions = $110.00
Soul Care does offer a sliding fee scale based on income.
Diagnosis
In the event that services provided are billable to insurance, it should be noted that health insurance companies require that a diagnosis of a mental-health condition be indicated before they will agree to reimburse for counseling services. If a qualifying diagnosis is appropriate in your case, I will inform you of the diagnosis before it is submitted to the insurance company. Any diagnosis made will become part of your permanent records.
Confidentiality
I will not release any information about you to any person or agency without your written consent except as noted below:
As a Licensee of the NCBLCMHC, I will abide by its Code of Ethics. To maintain my license I am required to participate in frequent continuing education, taking courses with subjects relevant to this profession. I also participate in supervision and consultative activities with other licensed therapists and counselors in order to support my work with clients. Any information shared during the supervision is discussed for professional purposes only.
All information shared will be kept confidential while receiving services with the following exceptions:
a) The requirement to report any suspected child or elder abuse or neglect, to the relevant authorities.
b) If you are believed to be an imminent threat to you yourself or others
c) If you give me written permission to disclose information.
d) Reporting information required in court proceedings, if court ordered to do so.
e) If you desire to seek reimbursement from managed care, insurance company, or other relevant agencies, release of confidential information may be required for reimbursement.
f) In the case of a medical emergency.
g) Providing information concerning licensee consultation or supervision.
h) Defending claims brought by client against licensee
Even under these circumstances only essential information will be shared and as much as possible you will be informed before confidentiality is broken. In the event that the client is a minor, parents or guardians may be included in the counseling process as is appropriate, and always acting in the best interest of the client.
Telehealth Counseling
Telehealth Counseling is similar to face to face counseling, except sessions are conducted either over the
telephone or over the internet using software that can be downloaded to your computer or mobile device.
Although face to face counseling is the preferred approach for conducting therapy, electronic forms of counseling
can provide therapy services for clients that have extenuating circumstances.
Forms of Telehealth Counseling: I currently offer internet and telephone counseling:
Benefits/Limitations of Telehealth: Counseling As stated earlier, electronic forms of counseling can be a
helpful alternative approach to traditional, face to face counseling, however, there are some limitations that could
impede the therapy experience.
How to contact me:
Ø When not in session, you can call me at 336-937-0331. This is a confidential voicemail.
Ø You can also text or email me. Email should not be used for appointment cancelation.
Ø If you are experiencing a life threatening emergency, please call and dial 911 or go to the nearest emergency room.
Ø I can be reached by phone for quick questions or appointment changes.
Ø In case of an emergency, please provide an emergency contact to the Front Office if not included with your Client Registration. You may call us at 980-613-8312 -OR- email it to [email protected] -OR- fax it to 888-972-4998.
Termination
The end of therapy can happen for a number of reasons:
Ø The natural ending of the counseling relationship. We will talk about the end of therapy from the beginning. We will discuss the ending process and start meeting less often to help with termination. At the last session, we will go over a termination agreement with suggestions on what to do so you can continue to thrive without counseling.
Ø If you feel your needs are not being met. We can reevaluate goals and see if it helps. If not, I can refer you to someone else. Please do not just stop coming. Allow me to help you find the best counselor for you.
Ø If it appears that I am not the best fit as a counselor for you, I will discuss it with you and will refer you to someone else.
Ø Services will also be ended, if you miss two (2) scheduled appointment in succession without any notice.
Filing Complaints
If we are unable to resolve difficulties or if at any time you feel that I have treated you unfairly, unethically or have violated your rights in some way, you do have the right to state your concerns to the board at:
North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC)
P.O. Box 77819
Greensboro, NC 27417
Phone: 844-622-3572 or 336-217-6007
Fax: 336-217-9450
E-mail: [email protected]
https://www.ncblcmhc.org
